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APPLICATION FOR SANITATION PERMIT <br />Permit N�����. <br />�^ ( <br />in .Date Issued . ��� <br />� <br />Appl'ica+'ion is hereby made to the Su 'Joaquin Local Health District for a permit to construct and install the work herein described. ^^ <br />/ <br />This application is. made ^'^-^'r~^^~ with ^~~^', OrdinancelNo. 549 <br />JOB ADDRESS ANDkOC.ATION ------- Z ---- ;_ ��_ ------ �.­ — ----------------------------------------------------------- <br />----------------- <br />Owner's .,~.-------------- <br />/nonxxonon will snn^° neuoo <br />-Number of living_/----s4vt Number of baths. ' Lot size-- '_-' <br />' �� ��� ��� ��� � Community system P��� Depth to Water Table __X ' ` --... �~� <br />� Character soil to a depth of 3feet. Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay F AdobeHardpan E] <br />Previous Application Made: Yes.`New Construction: Yn��� No [� <br />` � -� <br />TYPE {]P INSTALLATION AND SPECIFICATIONS: <br />(No septic tank mrcesspool penn|M�d'� public sewer isavaOa6|ewithin 200 feet.) <br />` <br />Tank: Distance from neonesfweU------Di,+mnco from foundation -------------------- Material ---------.---_.__ <br />W]i ;�_- - !Nv. of compartments -------------------------- Size -------------------------------- Liquid dvoh-'_---_-�upuc�y._----' <br />. . ` - <br />- Di�uno:�pzm neures �vU�-'-'''D�+once from f"un�u��n_''-_'-'Distance to nearest lot line ------------- <br />Number 'of lines ----------------------------------- Length of each line _--_-.- �� ---------- Width of french ------------------- _--_ <br />- �����,m���L �����,���| �� �n�� <br />'. '---'''-''~ . '--'-''�� ' -------------------- ''-'-'--Seepag� Pit: Di;fance"fo ne�resf well-----7-1----e-'----.Disfa"'nce Tf m, fatinclafi6n --- ------- Distance to -nearest lot line ...... <br />' /. <br />4\ <br />, : - x <br />[ C00000: Distance from neonssf well ----------------- Distance from foundation '_,~''`_Lining material -------------------------------------- "INA <br />[� S�e-Diameter�---!-/-�----�--_-Dept ---..---_-_.----._-..Uoui6 Copac�y.-__---.gu|� <br />, ` <br />Privy: Distance from nearest w=||'''-''-''--''-''�-'-]}istanco from nearest building '-''__'-'--'-'--- <br />' [] D/ | |i ' - <br />� V -------- tx� ,LAZ ----------- <br />---------------------- ----------------- ------------- ----------------------------------------------------------------- -_'-_-'--'--'''-''__.---__''-''--''---'--- � <br />I hereby certify that -I have prepared this application and that the work will be done in accordance wifh.San Joaquin Coun <br />ordinances, Statodaws, and rules and regalitions of the San Joaquin Local Health District. <br />i -lot, location �f system in relation to wells, buildings, etc., can be p ed on reverse sideiv -- ---------------- <br />(Plot plan, showing size o <br />DEPARTMENT USE ONLY <br />\` <br />APPLICATION ACCEPTED 8Y. ` <br />KEY|EVVED BY -------------------------------------- ---DATE-----L-�-_�___.- <br />UU|UD|N�� PERMIT |SSUED.�-.--.---��.--_-_-_----.-----_-' U�TE-----._°------_______ <br />-'--.-_'-_''''-''---'_'---''.'_-''-'--'''-''''-''----''__'--'''---'----''__''-'__.''-------.'_-'' <br />---------- ----------------------------------- ------------------------- ,-'''--------------------------------------------------------------------------------------------------------------------------------------------- <br />-------------------------------------------- -------------------------------- . ' . ^ ^ ^ <br />.-------------------------------------------------------- --------------------------------------------------------------- --------- -'�'_'''-_'''_-''-----''-'''-'-''-'--. <br />. - . . <br />~^�- <br />FINAL INSPECTION �BY��.. ------------. ` Doh�--�'��-'����-�-��]--------'_-_. <br />SAN JOAQU|NLOCAL HEALTH DISTRICT - <br />` <br />130 south American Street ~ - ----300 West Oak Street /32 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />1_Z_9 -2M Revised W-2100\ <br />