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-- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...114-7-- ----0 <br /> (Complete in licate -701 - <br /> Date Issued -3 <br /> - Applicat_/jTZbv;n,;1/. *<ion is hereby made �1, - t e%' <br /> oaquin Local Health District for per if to consfrupf and install the k h cribed. <br /> yr erein <br /> This application is made in compliance with County Ordinance No. 549. <br /> 71 <br /> Addres <br /> Contractor's Nome'. _--__------- ----- Phone ? ---------- <br /> Installation <br /> InstaUationwill Residence <br /> Number of <br /> . ber of baths _-_-Z. Lot size <br /> "&- <br /> Water Supply: ��� �� [� <br /> oo � nmCommunRy �dem [] P�u ' Depth VV --_ <br /> tou�rT� � <br /> |- � ft <br /> Character of soil to m depth of feet. Sand E] Gravel E] Sandy �'Loam E] Clay Loom E] Clay El Ado Hardpan [] ' <br /> Previous Application Made: Yes [] N"X New Construction: Y No F-1 <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer lsavailable within 2O0f*e+J i <br /> "~ ' <br /> No. f compartmentsSi L <br /> r Disposal Field: Distance from U 4' .-0i,tonca from f�o"�ut�on'^�.e�' Distance f rt | line �� '1 �� <br /> 7--- - --- ' -' ~^ <br /> Type of filter maferiaIo-o_-?-7Z Depth of filter material-- Total length------ <br /> See Pit: ' ' �~~ <br /> p -Lining materia <br /> --------- <br /> Cesspool: Distance from nearestwell Distance from foundation Lining | <br /> Privy <br /> -------------------------------------------------------------------------------------------- <br />. - /or re. ~ ` . -- _ _--.. _`~_-v,_-------�--..�-~ ------------- <br /> g,------------------------------------ <br /> ------------------------------------------------------------------------------------------�----------'----------------------------'' '[ � <br /> 4NF-------- <br /> '-' ---------------------------------------_---------------------------------------------------------------------------------------------------------------------------------------- ------------------------- <br /> ~~� <br /> --''----'�'--' —'--'--''----''---'-----'-'---------''--'-----------'--------'------- ~D <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances. St ws, anda ules and r�_ Iafions of the San Joaquin Local Health District.' Nl� <br /> (Signed) ' <br /> ~- <br /> o <br /> g size of lot, location of system in relation to "wells, buildings, efc., can be <br /> (Plot plan, s�o__ ed on reverse side <br /> F RR�FARTMENT USE ONLY <br />| - <br />� APPLICATION ACCEPTED "'------- _.. vn/c------:o�c/70W7/5'��._____ <br />� <br /> REVIEWED BY'-''--_-.'-'----''--'_-'-''----'''_-'''''''''-_.'''---'' DATE <br /> BUILDING PERMIT ISSUED------------------------ DATG------_._----.--.___ <br /> Alterations and/or recommendations:--------------- ----- ------------------------------------------------- --------- <br /> -----------------------------------------''''---'''''---'''—'---'—''-'-----''-'''--'''----'''--''-'-----'--'--''---' <br /> '------------'---------------'------------------------'------------------' <br /> --------_--_---__--------___'_---------_-------------- -------------------- �----------------------------- -------------------------------------------------------------- ------------------------------------- <br /> ------------------------------------------------ ---------------____�___--------___- --------------------------------------------------------------------------���----_ --------------------------------- <br /> FINAL <br /> ----------_RN/\L INSPECTION BY: -----'\/..��V�U���/�"-------- --------------- Date---------- -----..--'''--'-'''-'_'-''__ <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> /m sv.m American e=^w 3ooWest Oak Street � uz Sy="mv*° Street wf North ^C^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> � <br /> ES-9-2M 10-52 Revised W-2100 <br />