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APPLICATION FOR SANITATION PERMIT Permit No. <br />N *'` (C��p���0un�w�� <br />( ` Duplicate) Dat <br />aIssued ---- --1 - --- <br />��A,pplical-ionishoro6v mm6o to H`e San Jouquin Locu| Hou|H` Di�,ic+6r u pennit +ocpn�mc+ un6 install +ke°mrk herein 6e,c,i6e6. <br />T,application ismade incompliance with County <br />O"Ji-.�l� o 549 <br />JOB ADDRESS �w. <br />V <br />uwnar,m - ­­ <br />-_-' ----------Ph_o_no_^;Vd_-�/_���_'��_- <br />._.� <br />Address ......... <br />__.________-------------------------------------- ____ <br />____ <br />--.-.------.----P�one.c�s-Con�actn,'s Name e�m�m <br />Installation will serve: Residence CK Apartment House [] Commercial [] Trailer Court [] Motel [] C*hn, [] <br />Number ofliving units: /- Number ofbedrooms �.- Number of baths .^»- Lot size ... ~�..... <br />'. .411�..... ................ <br />Wohm Supply: Public system X Community system [] Private [] Depth to YVo+orTm6|elv..�. Hi <br />Character of w,i| to o depth of feet: 3on6 [] Gm,o| [] Sandy Loam E] Clay Loam [] <�|ny [] �Jo6ug Hm,6Fmn [] <br />P"e,iwvx Application. 44wdu; Yes [] No»�' New Construction: Yeo [] No �� <br />�� �� <br />TYPE OFINSTALLATION AND SPECIFICATIONS: <br />(No oeptic tank o, cw,qoon| permitted if public sewer ;s available within 2O0feet.) ' <br />Septic T Distance from nour:`+ we| Distance from foundation �6..^--�� iuiC»��..-'y _-. <br />w'~of No. nfcompa�monts--'^�----.-Size.4�/',�--.-----�quid6epfh-^^.^-------- Capacity ------------------- - <br />x , <br />Dispoo,| Field: Distance 6nm nearest ��[A0�4�.Diotunco from fnun6ution ---.Di,h,nnv to ooune� lot |ine-^. <br />�� <br />Number o{ lines .� Length of line . 9u ^ VV@t / <br />�� --'' - --'�~---'z- ^~ ^~^`^- ==*- <br />' Type offi|te, mutnria|'��xDepth of filter material -' )-C Total lemgth..-- 3,d.'._-'----.. <br />Seepage Pit: Distance to noumd well ------ from fomnJution--_--_Distancofp nearest lot line ----_- <br />[l Number ofpits -'-''_--Lining material ----------------------- Size: Diameter ....................... Depth ------------------- _---- <br />Coopoo: Distance from nearest well _—_- Distance {nom foundation ........ ---------- Lining mafa,wL---___-__.. <br />[] Size: Diameter ----------------------------- <br />......... Depth --------- ------------------------------------------ ............................ gals. <br />Privy Distance from nearest waU'----------- ---------------------------------- Distance from nearest building ----.--_-_------- <br />0 Distance to nearest lot line ---------- —'__--'--'_'-'_--------�'--.' <br />Remodeling and/or repairing (describe): ... <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 />ordinances, State laws, and rules and regulations of the San Joaquin Local HQ.alth District. <br />(Signed) ......... R014 ....... - - ----------------- 14ee_1_101"� <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED 0i-----_----------.-���� --------------------------- DATE._-'.r..-__-- <br />KEV|EVVED BY --------------------------------------- --------- -------------------- -_--'--'/�--------------------------------- DATE'_-- <br />BUILDING PERMIT /S3UBl_------''-_------'-------------------------------- .................. DATE ------------ '............ <br />'__-._______ <br />Alterations and/orrecommendations: --------------------------------------------------- ....................................... .............................................. <br />______... <br />'---'-----......................................................................................................................................................................... .......... ''--- <br />'.................................................... .................... --------- ....................... ........................................................................................ ---- ............... <br />...................................... --------- ------------------------- ...... ......................................................................................... ............... -----'----' <br />'-'-------------'------------------'---'-------------'---'---------'—' <br />SAN JOAQU|NLOCAL HEALTH DISTRICT <br />00 South American Street 300West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi California Manteca, California rm,^ California <br />eS-'v-cw ' Revised vv -2/00 <br />F.- <br />1� <br />� <br />