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-~ APPLICATION FOR SANITATION PERMIT rennn no. <br /> (Complete Date Issued <br /> 0�~AI-ANED <br /> a Sun Joaquin Local Han|fh Dist rictfor m permit to construct and install the work her!ein <br /> 800crl6e6. <br /> This application is made in compliance with ounty Ordinance N 49. <br /> N ' <br /> ---Contract ~—� --I <br /> Installation will serve: � . 0 �mmn�� � T��, <br /> Court [I- W����^� �OtherOther�r_El 5�.— <br /> _--- <br /> Numbarof6edmoms - -. Number of bath, .-/-.-/-- Lot sizeNumbernf |iving units: -/-' <br /> Water Supply: Public system E] Community system El Private to Wafer Table ff. <br /> Character of soil to a depth of 3 feet- Sand E] Gravel [] Sandy loam Ej Clay Loam El Clay El Adob� Hardpan <br /> Previous 'rr'--'ion— ---e: Yes [� ~~ x <br /> No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i <br /> (No septic o� R W� is available nnn �ou <br /> )-- ------------ <br /> Septic Distance Distance t � _---' <br /> ` <br /> Disposal Reld' Distance from nearest well-------Uistanco from foundation---------------------Distance to nearest lot |me----------------- <br /> Number o1 <br /> -'-'—Numbero{ lines----------------- -----------------Length of each line V�dfhcftnnch----------------------------------- <br /> Type <br /> --'---.—'—' <br /> - <br /> � Tvpu of filter mato�oi''''_--�---Deo+h filter material <br /> -`Tn+al lenotk_-.—� -o-n_-----.--- <br /> . to nearest <br /> ----- <br /> Seepage Pit: Distance to nearest wDistance fell »/u�v'= —�oo� — '' ---''_'Num�er of pits- - nmu�e,y - <br /> / |� D6f ncv from ncu,e, w�L'--��'-Di�ancv from fnundohon'-_—'--Un�g material-------------------------------------- <br /> ~�~ r-- <br /> El ' Size: Diameter-- ----------------- -----------Do+n .- �� .�qui6 Capacity gals. <br /> Privy: Dida"cn from nearest we|L'—''�'''-''--.—'''—'Di�a�co from noarosbuilding--__-.—__---- <br /> �� Distance fo noo,os �t line �. ' - _-''_-____'_______ <br /> �-__-_-.----------_------_----- --------- <br /> Remodeling and/or repairing (describe):-------------- -- ---- ----° -~ ------- <br /> ----_-..-_-_----.------------_---_-__-__--._'-__---..__---_-_---------_-------- <br /> ._--.-_--._--.__-_---__—__--__----_-_.-______-__-'__'--_---.__.___---_--.�. <br /> -------'--_--_----__-___. -_--'__-__-_-'-'''___'''-''''__'''--'-''---'''-''-'-'-''-' <br /> I hereby certify that I have preparedth& application and that the workwU be done in accordance w � Son Joaquin County <br /> ordinances, Sfat <br /> Vlaws, <br /> ' U <br /> w be pla- on ray <br /> (Plot plan. showi Sze of lo(, iocafion of system in relafion to wells, buildings. etc., can <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_:� <br /> REVIEWED ~'-''--'--''—'-`��r'—� DATE j�� <br /> BUILDING PERMIT ISSUED_--_--''-'''---''--'''---'------'''-''-'''''-'' '— ~v -----''''-''----'—- <br /> Alterations om6/*r rennmmend afiono ---------- ----------------------------------- ------------------------------------ ------------------------------------------------------------------------- <br /> . <br /> - --------------------- --------------------------------------------------------------------------------------------- ----------------- --------------------------------------------------------------------- ----- <br /> ^ ``----`�--`--`-````-'`-`----``-``�```—``---```-----`-````�``--```�--``--``--'``````--``--'`-``--`` <br /> ---------------___ ---_-----_�--_---------------- _ --------------- _--------------------------------- ------------------------------------- --------------------------------------------------------------- <br /> ------'''''�--''' --''—''''''-_ ''-'''-''-''-''--_ <br /> [ <br /> � RN/\L INSPECTION BY: - --_---- Du+�.--'// --__ --���_---_-.� <br /> ` ^ SAN JOAQU|N LOCAL HEALTH DISTRICT ' <br /> 130 South American Street 300 West Oak Street /32 Sycamore Street $14 North "C" Sit"t <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />