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. APPLICATION FOR SANITATION PERMIT Hannit No <br /> (Complete �n Duplicate) ' �' <br /> -- Date Issued ----- <br /> / ' <br /> Application -mmdn to the San Joaquin Local Health Dkd,ict for permit +o construct and <br /> install the work herein described. <br /> This application is made in complian'ce with County Ordinance No, 549 " ,/I <br />' JOB ADDRESS 1A1 ai�zAVi LOCATIO�N ------: If . - <br /> Owner's NameA Phone <br /> Contractor's Name- <br /> Installation will serve: Residence 41,� Apartment House [I Commercial El Trailer Codrt Ej Motel F <br /> 4 f baths Lot,. <br /> Water Supply: Public system E- Uommun"ity system 0 Private X] Depth to Water Table AO <br /> Character of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loa m Clay Loam E] Clay El Adobe Hardpan 0 <br /> Previous Application Made: Yes E] <br /> No N New Construction: Yes No"El)-fHA/VA: Yes El No Ej <br /> . /rE OF INSTALLATION AND : ' <br /> -==^� /N000p+�'fank / � <br /> ��c Tank- Distance from nearest well Distance from foundation M`at6�~~-i«~L-141 No. of = _~ ~' -----3�o_-4A- ''Liquid ueRf ------4---------------- <br /> ~»-Capacity <br /> ..Tf'o-'o------------ <br /> Distance <br /> ''-'-�- <br /> - <br /> Dtncn f ,m nearest <br /> , well. - ;D�pos | Field: '~' --D�f nce from 6oundotion-'-1 0--'.D/ ^a~non to^ nomm <br /> sf �t |ine__- <br /> -''-Number of |�me�|-'-°'--- Length of each |� ----------------- <br /> -__ 'Wi6t' - ~~^ <br /> [ypu of fl+er material' �= `» � Doof of filter material---V%--------------Total lengf�..�7�.`-'".___ <br /> ------------ <br /> Seepage Pit: Distance to nemrn,o °eL-__-'_.Di�anc= from foundation Distancefonoaremt |ot ||no----------------- <br /> F1 Number ofpits 1�------------------Lining'-m-u�te-,i'u'L'--'--_�-'-''-l-/ Diameter----------------------- <br /> -~- ---^-Depth <br /> : Distance from nearest well----------------- from foundation ''- -Lining material -''-[ Size. Diameter--- uvpr . / C ------'- <br /> ' ----- - --._. -_ oui� op�ci��--''--- '--gals.Pri,v Distance from � Distance m nea' ~~~ 'y Osf ncofo nearest lot kn�-''' <br /> Romo6el;ngrepairing <br /> �^| <br /> �nd/�, rnpo/ringk]ooc,� � )�-_ ------------ )'-'''_'--_-'__.-' - '~~~~- <br /> '--'--_-�--_''-'-`'-_.._.-i_- ^� ^. _^ ' ' --'--'--'--'-----''��'------''-'------��� | <br /> ' '- . '----'-_---------'----'---------_---_-__________ r ` <br /> _'---'_-_-__.-___-.-_'-`__'-__''-_-_-__.'_- <br /> --'--_.'_-'--'- - � ''-_.'__._'__-____-----_---__'----.__-. _ <br /> ' _-_-____.'--_-.-_-___.---'__-'_-_ ' , <br /> hereby certify that I have prep6ed this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> .°' <br /> � <br /> , � <br /> ~ Owner and/or <br /> By ----------- <br /> ----------------------- <br /> _ -- - - ' ~�--- -- ~ - <br /> (Plot �nshowing size of lot, ' --''''--�'-`--' <br /> of system inixelation -to wells, buildings, etc., can be placed on reverse side). <br /> � <br /> F OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- <br /> Alterations and/or recommend a+iono-i---''---_------------- <br /> ------------------------------------------------------- <br /> � <br /> � '_----- � �_-�-_.'-' ---'�-''---'-'--� -_ __-''-__-'-'_-_--_-__..__ ------------------------------ <br /> ---------------- ` �� <br /> ---'__.--_-''-_''___..�___ | _ '''--''---''---'--'''--'''--'--'------''-'- | <br /> -'-_''-''-_-.'---'-'---_--�''��'''�''-�-_LOCAL <br /> -' - ''_ ' �- '- � -_--_'� ���-_--- . <br /> RN/\L INSPECTION 8Y /�- <br /> .___.-_.__. Du�,.^'-.'���-'���---'--''-''-'--'--'- ' <br /> SAN J�f��'UUN �Ow�ALHEALTH DISTRICT ' <br /> oo n""a American �,�^ mmvv°� o° s*°� /zo sv""m"� e�.* 814 North "C" Street <br /> Stockton, California / Lodi, California Manteca, California Tracy. California <br /> ES-9-2M n""u°d 1.57 p.rzn / <br />