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.~ <br /> « <br /> APPLICATION FOR SANITATION PERMIT Permit No. .4--- ---If <br /> ^ ' ' ' ' Du+o |omxyJ <br /> ��7- 7 ----- <br /> Applica4-ion is <br /> hereby mm6o to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> This application is made in compl' c With C unity Ordinanr-o No. 549 <br /> JOB ADDRESS A�V/ <br /> 'd---- --------- ------- <br /> .... Phon/0--- <br /> Installation will serve: Residence Apartment House [] Commercial [I Trailer Court El _Yotej Ej Other <br /> Water Supply: Public system El Community system E] F VDepfh to Wafer Table -------- ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam Clay El Adobe 2---`Hardpan <br /> Previous Application Made: Yes E] No E] New Construction: Yes F1 No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if Vbyc sewerpk <br /> - ^ <br /> 5o nk: Mstance from nearest weli,--P-Tvn ----------- <br /> is <br /> q�&io,-W� ---------- <br /> Di` Field: Distance fi-orn nearest from foundation <br /> V Number of lines----- /7 Length of each line--------------- --.-.Width of french-------------- <br /> -------------- <br /> Type of filter mater 41�PA�epth of filter mater�al----------- ----------Total length-----------1-22)--------------- <br /> Seepugo Pit D�sfonce to nearest welL--''--'-Distunce from foundation-------------------Distance to nearest lot line----------------- <br /> El <br /> -''__--[] Number "fpits----------------------Lining material _.----�--Size: Diameter---------------------Depth------_'_- <br /> Coepoo|: D�st no, from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> 1771 <br /> _'�--'-''_-----[] Size: Diameter-------------------------------------- -------------------------------- -------------Liquid Capacity-----_--..go|v. <br /> Privy: Distance from nearest well _'_-''�-�'------------Distance from nearest 6uilding ----------------------------------------- <br /> Distance <br /> -''''_-''_____''' 1 <br /> LJ Disf nce to nearest |o+ |inc- �----�---________�_�__._______.__.__________. �~ <br /> ____��__________'____'___'_____________________________ , <br /> dt <br /> ��^� .~��. ~�\, ^ - -'--'---'--''----------- -----'----------- . l ' <br /> nm��^^~��- ---n---- ------ _.___.____.__.__..___.____.__._______._________._.. <br /> ------`--------------`-----------`�----------------`-----`---``------'----``��``-----------------```-------`-------``-------``�---`---`��'---`------'------'```-----`------------------ <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> (Signed) '- <br /> ' <br /> ` ~ *areg�ulafi <br /> - --------------------- -----------------------------------------(Owner Cmntracror <br /> By:--___..______---__._.---'---------------__-.------]Tif le)-._-.-__._---_-__--_--__ �c ' <br /> (Plot plan, showing size of lot, locati on of system in relation to wells, 6uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY ------- ~-^ <br /> -----------------------.---------- ---- -------------------------------------------------- ---------------------------------------------------------------- °~^ <br /> -------'���------------------------------------------------------------------------- <br /> ------------------------------ ------------------------------------�'' ------------------------'------ -'''-'''_'''_'''-'�'''-''-'------''-''''-'--.. <br /> -'�''--------------------------------'''�---''`-''--'�� --'--''---'''-''''-��''-'''--'-'''--'''-'-'---'-'-'''- \ <br /> ' / <br /> FINAL INSPECTION 8Y--- �''' &x �.'''-' Dote----- -- ---------------- <br /> SAN <br /> - -SAN JOAQ0N LOCAL HEALTH DISTRICT _ <br /> ov n"wm American Street amWest Oak Street ox Sycamore Streeow m"*h ^C^ Street - / <br /> Stockton, California Lodi, California Manteca, California Tm"'. California <br /> ~' <br /> ES-9-2M x".�s°a vv-2:00 '~~, <br /> --- - <br />