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APPLICATION FOR SANITATION PERMIT <br /> Permit No. .. O.3 �ss.. , <br /> (Complete In Duplicate( Date Issued <br /> y r' ._7.,, .�'.... .. L!. . cl Y.. *y�prwork <br /> ,efion is hereb made to the can Joe uin Local Health District fora ermit to construct end install the rein described. <br /> oplication is made in compliance with County Ord' No. 549.��'�' ////n���� <br /> 4DDRESS AND LO` TION <br /> +p <br /> sName............. ............_.......Y..... . .......................................... PhoneAQ._,5... <br /> ........... <br /> its.......................... ((// SlJz,.;r.�........ .................. ..._................ <br /> ....... <br /> ........... <br /> ............ <br /> .................................. <br /> �� <br /> actors Name..1.1.Yr... f .Ai �.:L............ .r... '...._.�i..r.;._w........................:........ Phone...f/,o....2i.J(J.Xs� <br /> anion will serve: Residence Qj/l<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ] Other ❑ <br /> Number of living writs: ..fo <br /> .. Numer of bedrooms ...r-Number of baths A*... Lot size ...s� ........ �I <br /> r Supply: Public system ❑ Community system ❑ Private &AMPth to Water Table .5.6t. <br /> eater of sell to a isphis of 3 feet: Sand❑ Gravol❑ Sandy Loam❑ ClayLoam❑ Clay❑ AdoLis�erdpan❑ <br /> ,us Application Males Yo ❑ No B�NovO`Construefion: Yet ❑ No 0j,-`FHA/VA,lin[] No Ce--- <br /> OF INSTALLATION AND SPECIFICATIONS: a� <br /> (No septic tank or cesspool permitted If public sewer C�available within 200 foot.) , <br /> n / t <br /> ;c Tank; Distance from nearest ws11.L..D�.Dutanc from" f2�un etion.../((.....MefeneL.......Lr...:':"Q:: .L... .�.�....._` <br /> �./ No. of compartments.......3e�..._.,-Size.��fr]C.Jj6.!!Uquid depth....wi��.��......capacity....8.4d ...... <br /> Dsal F' Distance from nearest well'&....Distance from foundation...1e_.....Dis#once to nearest lot <br /> ✓ <br /> Number of lines........`. .... Length of eac{I line V0. .......Width of trench....C2..91(C............... <br /> type of filter materiel...... ../Cr/{....Depth of filfermeteriel....../.. .....Totel length.........Ej�Q_.:................... <br /> 'age Pit: Distance so nearest wel��.�..).....Distance m oundetion...Q..........Di1�feSSnce to nearest lot Iine.3.Q..... <br /> Numberof pits.....I........--Uninp4eater�ial,�.,�i:tr.�..u..Size: Diamotor.....�Jry-....Depth ............. � <br /> 14 <br /> ;pool: Distance from nearest well......,n. ...Dn1'ance"Yiom foundation .... . .... .Lining material ...... <br /> -71 Size: Diameter . . .......... . ...L...... Depth ......... .... Liquid Capacity. . .. _.. .. gels. <br /> y: Distance from noarest well............ . . ... ....w, ..Distance from nearest building _. _ . <br /> ❑ Dister,_e to nearest lot line...... . ........... .................::':........................................................ <br /> . <br /> -nodali g end/or repairing (describe):... ........11.`{�Le( e .. �.' fr:..t�...... .........f3. !i...S. .�.�..:..�t................. <br /> _.... ..................................... . <br /> "`'7" .. ....P�. . <br /> ... ? '. �.- ................ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> iinances, La�ttee laws, and rules and regulations of the Sen Joaquin Local Health District. <br /> 5 r _ V-CQj: ..... -Z::...... ...............:r............._ .(OwwewerConfrector) <br /> 3ned .._Q.. _.._.1.�...... ..�..C./t/. . /� <br /> By:.............................._..... . .... �..........!. f .........(Title)........._ ... .__....... <br /> . ... <br /> of plan, showing :do of lot, location of system in relation welis, buildings, �}c., can 6e placed on reverse side)._ (� <br /> FOR DEPARTMENT USE ONLY <br /> 'PLICATION ACCEPTED BY ......................... ....... DATE............ l S <br /> :VIEWED BY...... . .. _. . ... ...................... DATE...... .. ..... <br /> 11LDING PERMIT ISSUED.... ... .. ... ..... .... ..... ....... <br /> DATE..... .. .. �.. <br /> ,ferations end/or reeommendafions . .... .-_if __. .. . . .. ......................................... <br /> .......... <br /> ..� <br /> . __... . ._ ._ ... .. ...................... ........................................................_.. ,. ......_...... .. .. . <br /> _._.. .. .... ... _... _. .. .. . . ... _. . ..... .... . . ......._. ....._ .. . ................ <br /> . .. ... ... .......... <br /> F1tIAL INSPECTION BY:. _ _ Date. /. .� - .. .. ._... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UO Soeth Aman.&- Street 300 West OeY Street 132 Sycamore Strut 014 North "C' Street <br /> AecNon, GClornia <br /> Lodi. Cellfom;,, Montego, Ca140r614 Tracy, CdHernia 1, <br /> r :M Re,too `,l rcrn ' <br /> !A' <br /> P <br />