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VUR Q+iICEUSE: <br /> � <br /> .� - -- --- <br /> * <br /> APPLICATION ��� SANITATION PERMIT Permit 11 <br /> (Complete <br /> ' —' 'rom Date Issued Do+a |om�� ... <br /> �����������---.. —'�----_ <br /> res <br /> ear <br /> Application is hereby <br /> m to the San Joaquin Local Health District for o permit to construct and install the work herein described. <br /> This application b d ino|� with County ~- ' <br /> JOB ADDRESS AND LOCATION. <br /> Installation will serve: Residence part ent Ho se F] Commetcial I-] Trailer Court [3 Motel El Other <br /> Number of living units: �� Number of bedrooms #--- Number of bafhs Lot size <br /> Water Supply: Public system P-11`Community system F] Private [] Depth to Water Table6_, ___ ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy Loam F] Clay Loam F <br /> ] Clay [3 Adobe Er-lHardpan E] <br /> Previous Application Made: (If yes,date-----------------.1 No El-, New Construction: Yes E3- "�o E] FHA/VA: Yes [-] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No xnpfic tank or coxsp**| permitted if pu6|/cvm"e, isavailable within 200 feet.) <br />- <br /> Septic Tank: Distance from // ' <br /> ^I~- �]� M�. pfcompurtmanf,---.��Z��-..S|ze-^��� / -�qui6 ��pf / � ' <br /> Disposal �;|6� D)'+unco from from foundationDistance | ^--/ <br /> Number of lines-------------- of each line--- ' -.�Width oft,enc -�-' <br /> Type of filter material .�7�y. pth of G|+or mmte,iuL..Y'F -Total |enq+k-_ <br /> 0- <br /> Seepage Pit Distance to nearest well----------------------Distance from foundation--------------------0isfanos to nearest lot line-_---- <br /> LJ Number ofpits_'''-''''Lining material----------------------- Diameter-----------------------Depth ---'-'-'---- <br /> : Distance from nno,e` wo|------------------Distance from foundation---------------_Unirig material �'—_--._'-- <br /> LJ Size: Diameter -----------------------------Depth—''''-'''�'--'—'''''--Uquid Capacity----------------------------gals. ~� <br /> Privy: D�s+ nce from nearest well-------------------------------------------------Distance from nearest 6ui|ding'--------------------------- . -Dis+ono, to nearest |o, |ine`-_----.-_--._-------_-__._-.__--___'_--._--_ <br /> Remodeling and/or repairing (describe):�s � , <br /> _ --''_--'�—��-�'--''-_-''----''-_.-_---------- � <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------___------ ---------------------- <br /> _----_----._--_-_--_-____._.___.-__..___'__-.___-_'___--.------__-.---._--- <br /> ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- <br /> hereby <br /> ,es Stat and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION <br /> BUILDING PERMIT ISSUED-------------------------------- T ----------------------- <br /> ,�� � --� -- ���or �{�_ <br /> ----r---`' ^ ^' =--- -�^�=���-.���.----_—c�.. - ����-�� =-` <br /> '--' ,-���t�/�`--_--_______________________._____ ------------------------ <br /> ----------------- <br /> .— -''—��--'''----__''--'�_-'''-'''''-'''-''''''_''-''---'�''-''-''--'--''---' <br /> . RNAL INSPECTION BY:--~� ' ___ Dmh�_�� e� �/ <br /> . ------''_-''--- <br /> /S�NJO����UNLOvC�LHE�LTHCUSTRkCT ` <br /> 1601 E.w*.elm"A..° zovWest Oak Street 1o4Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> "° " =""'"""S'S° "M o'°" "~Co. <br /> ~- - � <br />