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~~ <br /> ~- �PUCATION FOR SANITATION pERVIT Permit No. <br /> ��mp|�� � Duplicate) <br /> ' ' ' Date Issued <br /> ~~ <br /> Application is hereby mu6o to the Son Joaquin Local Hoo|H` District for o permit toconstruct on6 install.fhe work herein described. <br /> This application is made in compliance with Courify Ordinance N <br /> JOB ADDRESS '`.`� ---- ----- '� --------------------.---.. <br /> Phone------------------------------------ <br /> Owner's N -�~ <br /> Installation will serve: Residence [A;`*Apartment House 0 Commercial F] Trailer Court E] Motel [:] Other 0 <br /> -- Number_ of 'living _i- ' bedrooms_ �Avate <br /> N_'-_ --- <br /> _ --�- ' --t -ize_ -------- ..---._----- --' <br /> Water Supply: Public system �� Commu�y system [] Depth rTo6| ft t- <br /> ----------------- <br /> Character of u,U to a depth of feet: Sand Ej Gravel [] Sandy Loam VClay Loam 0_~61ay0 Adobe [2] Hardpan [] <br /> -- <br /> Previous Application Made: Ye, [] No Ej-~"New Construction: Yes FHA/V& Ye, 0 No El <br /> � <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if 6|iiavailablewithin200 f � <br /> So Distance f '��0��_ Di from i <br /> � Material .�����-�� <br /> - <br /> � ��"�� �_ � �No. of compartments-_:0 � Si ' - ' � -Uqui6 6e' � - � ��.� ---.Copu�t�.'� x !-_'� <br /> r <br /> . Distanceneaest Disposal Field: Distance ~1�� f <br /> -------- <br /> Number of | Lengthof each | <br /> of material bc'D��� of ��e, mu+o�oL.���.���. -.To+ | |ong+ -�I�Z�--------------------- <br /> Type <br /> � -lr'--`- ~ ��_~ Soepo Distance to nearest well_�iM ' <br /> �l^� Dist � to <br /> Number ofpi�-' ---------------Lining material 3�e: Diomo+ec--VO-1' -' <br /> Depth-vs� 4.1'� .. <br /> : �-. <br /> Distance | <br /> ~~ E] Size: Diameter------------- -------------------Depth----------------------------------------------------Liquid Cupocity'--------------------------gals,--- <br /> Privy: <br /> ls.~~Privy; Distance from nearest well------------------------- ---------------------' from nearest building <br /> El Distance to nearest lot |ine---------------_ _-_--'-_ <br /> , - <br /> ~~� RomnJeling and/or repairing (6esc,i6o):--------------------------------------------------------------------------------------------------------------.......................................... <br /> __.-___---__---_--__---_---_.__-._.____-_--_-__'_--__--'__-_--''-_--_-._-_'_-___. <br /> -_- '_-_ --__.'-� � <br /> _- -------_---_--____-'_----__-_------_----____--_--___-____-------_--__---__-.---- _ <br /> ' | hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ^ <br /> ordinances, State laws, and rules an regulations of the San Joaquin Local Health District. <br /> -~ ��n .-_-.------ �pnt��p� <br /> -,'__-_____--____-_._----.� -.-_._ --.-__-----,--,-_---_'_-_------------ <br /> /� ��. � � � ��n � �� �m|a� � we|�.�6�ingv. etc., can be placed on reverse side). <br /> � <br /> FOR DEPARTMENT USE ONLY <br /> er <br /> -- REV/EWB} BY--------------------------------------------- ------------------------------------------------------------------------------ DATE--._.__--.---_______.__ <br /> 8U|LD|NG PERMIT ISSUED ---------------------------------- DATE_----.---_--_.____-___ <br /> Altw,u+ions and/or recommendations:--.'---'-------'--'-- <br /> ~~ ---_.---------'--'_'_-__-----_----.-_--._-___'______'_-_--___-___---'-___-----'---_----..-- <br /> -------'----------------------------'----'---------------------'--------------- <br /> --------------------'-------------------------------- ---_----------_��������............................_ <br /> �- ---------------------------------------------------------------------------------- ----._'---.___'--__----------__-----__---_--_' <br /> � <br /> FINAL INSPECTIONBY --------. Date--- :17 <br /> - SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /m South American Street 300 West Oak Street /su Sycamore Street m* North ^o^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ^� <br /> - <br /> ES-9-2M K°.iseci 1.57 F�pzo <br />