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F0 OFF S <br /> » y <br /> ------------- APmL / ON F0' R SANITATION Permit Nn J <br /> ' (� o /J/ ` <br /> @o �u��mf�� Date Issued <br /> ' -+^~'^�-^-- < <br /> piication is hereby made tothe San Joaq�nLocal Health D;��ctfor mpmnnKtoouno�un+and in�o||the wor 6em�ndwsc,�ad. <br /> T�isapplication is made |ncompliance with County Ordinance No. S49. <br /> �� ��� - ' i i:, <br /> JOB ADDRESS AND LOCATION_'�` <br /> Contractor's ..... ----------------------- .................. Phon�W <br /> Installation will serve: Residence C] Apartment House [] Commercial E] Trailer Court)< Motel [3 Other [3 <br /> Number of living unitsL.0--- Number of bedrooms ------.- Number of baths -------- Lot size ........... <br /> Water Supply; Pwb||o ayo�,m [] Community system [] Riv���r�^ Depth hu VVu+mr Table-.45-0 ft ` <br /> . . ��� <br /> Character of sail depth of feet: Sand ��| � Sandy Loam Clay Loam El � Hm��n � / <br /> Previous Application Made: (If yes, No 0 New ��onstmcf�n: Yeo 0 N nu�' FHA/VA. Yev [] No El � | <br /> � / it I 3V i�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � <br /> (No wwpfic tank or cesspool permitted R public sewer is available within 200 feet.) | <br /> ' <br /> Distance from nearest well-----------------Distance from foundation--------------------Material_..............................................a�4 ' <br /> No. ofcompurtmnnfo--------------------------Size............... ................Liquid cloof ---------Cu —._..—..- <br /> v � a�~^� � <br /> p o sX,i�el d: Distance from nearest <br /> __Distance from foundation--- <br /> _.Z <br /> - �/r- _ filter —___. . <br /> Distance to ~(A <br /> +h ' ~ _-'—'� Un�ng L D|om*+er-� — Dep <br /> —A - A <br /> : Distance' �/neona� vm|L--_--D|�uncofrom fuundutiom--------------------Liningmaterial <br /> � <br /> � <br /> �u�mr�L--.---_--_— | <br /> [] Size. DiaDepfh Liquid Capacity------__-----------------gals. � <br /> Privy- ' Distance from nouroo well'�' --------------------------------- -------Distance from nearesf um//d <br /> [] Distance +onearest lot ||no—-------------------------------------------------------------------------------------------------------------------------- ------------- <br /> Remodeling and/or repu[ring /Jo»c,�*\' .............-----_.— � <br /> `=�.. <br /> —_''—__--'—'---'--____—''—_—__- _'''--V-0- ......� <br /> '--'--''--'--'--'----'--''----------------- '-----------------------'------- <br /> hereby certify that I have preparedt6& application and that the work will be done in accordance with San Joaquin County ' <br /> nndmmnne, District. ' <br /> �� �� ����JL -----_--- ��*ntm*�mr <br /> By:---------------------- ---r(Ti'—,—'---------------'-- <br /> (Plot plan. showing size of lot, location of system in relati to wells, build4gs, efc., can� be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br />� ------- <br /> REVIEWEDBY_--------------------------------------------------------------------------------------------- ----------------------------- DATE''—_—__---''---'—''--- <br /> 80UD|NG PERMIT ISSUED-------------------------------------------------------------- ------------------------------------- DATE.—_.__._--------.--..—_.— <br /> AMeratimnuand/orrecommendations:-------------------------------------------------------------------------------------------------- ............................................................ <br /> ........._---------------------------------------------------'__'^ ---------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------''—'—'---''—'--''—''------'--'''-----'---''-----'----------''-'—'--''---'--- <br /> ^------'----------------------'-----'-------'-----------'-----'------- <br /> -'----'--'—''---''—''----''---'''—'''—''—'''----'''''--'''—''''--'—'—'''—'--''---'—'—''—'—' <br /> RNAL INSPECTION BY.—Q­__ ------------------------------- Duto —/ ------------------------------—__.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> "" 9 =°°"" "."" iIw w'°` ^,"`" <br />