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^ � ' APPLICATION �� ' �� ~- APPLICATION��T� FOR SANITATION PERMIT - (Complete in Duplicate) - ' | gp|]��on is hereby mn6o to the San Joaquin Local Health D�ri�f� n permit and install the �e°mherein described. ~ � is application is made in compliance with CvuntyO"dinan.ce No. 549. ' JOB ADDRESS AND LOCAT|ON--_-.. ..- --L%At----'-'-----------'- C)wner', Name--------------------------------------- -H@TIO0�- x8- -Auto..{�-ourtl------------- Phonn--LOCU------16S-. A6druo..7-'_--_.----t--------------------1506..�her-o-ke1e-..]-ta%%e.r---Iodt------------------------------------------------------------------------------ -------- | Contractor's* Name-------- ----------------------14_ ..��..��n'It%�-----------------,------------------ Pho»v-9.!!!9607--------------- Installation will ----'|nsta|lationvill serve: Residence E] Apartment House E] Commercial El Trailer Court Mofel [X Other El ) N��r m�1�v�� Number of 6o�r�om� �� N�o�8ffd~�� -[�FG��.�.��n��..��l��-�-��_�� Wafer Supply- Public system [] Community system [] PrivofvI� , Character of soil to m 6epfhof 3 feaf: Sand E] Gravel [] Sandy Loom E)[ C|uy Loam E] Clay E] Adobe E] Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic tank or cesspool penn|Me6 if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------k1*+eriaL---------------------------------------- / [] No. nfcompartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- �-,�f Cesspool: Distance from nearest woU�_----Di�ancefrom foun6otion--.-----Lining material-------------------------- 7_ ` [] Size: Diameter--------------------------------------Depth_-__--_--.--__----_ P,ivy: Distance from nmo,e, well ---._--__._-------------Distance from nearest building------ ----------------------------------- Distance to --_---'�-_--_-_- Dist ncofo nearest lot line'__.-'___�----''''-- --~ -Su'opoge Pit: Distance to nearest well---2{-0.x--------Distance fo�_Un6u+|pn -3Q1 Distance to nenn,`f |of |ine- ]-0«- -' ~ [ Number o4 plf, ---Lini�g ma+o,ioL-cl-1.`--------Size: Diameter---40e;..............Depth-----;X 490.--.---- ~ �_usposoLG |d:—Z]Jlitacefrom-nearest Distance from. m" -_--z-_-_ �Distmnce-to'n-ear st�Io+1inu-----_-' [� Num6er of lines-----------------------------------Length of each line------------------------------Width of french-------------------------------- Type n, ch--_-=.-__- Tvpo of filter material------------------------- of filter '--�. � ---------_m. ota,loL-.-'�� -------- -Remodeling and/or repairing (6osv,i6e):-----D4£pjement to existing u�� . � -.-_--.. .. `.. / _ ___.____-.__._-___----__---__----_---_------�-.----_-'_______.-_-.__-----_--__-_ ---------------------''---'--'-----------------'-----------`'---``-`--'--'`-----'---' ____---_------_._----_----_---------__--__-�__-_--�_--__----_-_.__..---_--_ U � � herered-this application and that the work will be done in accordance with San Joaquin County ordinances, Sfate laws, and rules and' regulatikiffs of the San Joaquin Local Health District. (Plot plans, s"wing size of lot, locatio system in relation to wells, buildings, efc., must be filed with this application).FOR DEPARTMENT USE ONLY ^ � ACCEPTED BY--._'_..�_-.--_�� -��-..�_-_-..' D�T5' --------------- APPLICATION. -- ' KB0EVVED BY--------------------------------------------- DATE'-�_- __'_--. BU|LD|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------- -_-__-------._-' AKermfionsmnd/w, ,ecommen6mfkxnn:--__-_----__---_,___---.__.-.---__._---._.___________..__-._- ' ----''--'--__.'''_-.'-_-''__.''-__.''_-----_.---__.'---_.-'---'_--__.'_-_-_-_'__.''-_.-'''---_- ----.--------'-----_---------_---__-__--_---'_-_--_--_��__._-___.--__-----_'�_-.___.- '---'-----'-----------------------------'-----------'--'------'------' '-'---''---''''---''--'''----- '--' ---''---'----'---- --'''--''--''---'' ----------------- PEK��|T Nv.��-�'.��-.. /SSUED'__��..�L�.��(D*fo) RN/4L INSPECTION 8Y ' � ' / Dot^_''�---'��z,!'' ---------- � SANJOAQU|N LOCAL HEALTH D|STR|CT |3OSouth American Street Stockton, California ` cs-9-2m 9-50 W4639 ~~� }