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. . � ^� \ APPLICATION FOR SANITATION PERMIT Permit No. ` (Complete in Duplicate) ' Date |ss6e6~_:_'��-°°-�.� � Application is hereby mn6o to the San Joaquin Local Health District for u permit +oconstruct and install the work herein described. ' This application is made in compliance with County Ordinance No. 549. ^"" ADDRESS AND ----- __j__,W47- -----46 ~'v,=^'+---�w°�=°=^�=~�~='^�"''x' ---''� Owner's N P�j -----------.-----.. Phonn..,I^..��^�;e..��-. ' ~~'~`�-- -=~~~ ~~'~~�------------'--------'-----------------' | � Contractor's Num�.-__,_--,-. -_-----_-----_-_._-.--_-- Phone..__--__-__._ | . �~ / |n�eUmf�n will serve: Residence -�K Apartment House E] Commercial 0 Trailer Court El Motel 0 Other [l Number ofliving units: Number ofbedrooms '�l--- Number ofba+h,"l-. Lot size ----��f b�. �n^�.---.----. VYafor Supply: Public system CommunRy system F1 Private [] Depth to Wafer Table -'-' ft � Character of soil to a depth of feet- Sand Gn,vo| E] Sandy Lo Clay Loam El Clay El Adobe Hardpan []I&J � Previous Application k1a6o: Yes E] No �� New Construction: Yes D� No [I ��~ TYPE OF INSTALLATION AND SPECIFICATIONS: -~ /No oopt�� tank or ne��p��| 9e,m��e� R pu�|�osewer iaavaUa6|owithin 200 feet.) . * ^ Septic Tank: Distance from nearest well - from foundation -k Liquid ��p �.. ^. ��---.Cupucim~ No. ofcompartments-.. ^��----Si ' y- � , � ^ Disposal Field: Distance from nearestwell 4 -D�fonua from foundation ---'Didnnce'to � n�une� lot line---- P91)9 Numb� of lines - ��' ' Tvpo u{ �| epf of filter mo+o�aL��..''''-�of�| �n�f6__-��A�.'__'--_.' Seepage Pit: Dist�nce fp neo,osf w°U-.---.._.Cdnnce from foundation--------------------Distance tohoanystlot line----------------- Number of pits ----- Numbu, ofp|ts-'''''-''''L|ning material---------- -----------Size: Diameter.----------------- ''Depth '_-'''-''----. Cessyoo|: Dis+ ncn from nearest well-----------------Distance from foundation-------------------- matehoL--_-._.__ [] Size: Diameter'_''--'''''--'-Depth--_'''''''''''''_-'''''-Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------D�stunua from nearest building----.-___---_ _ El Distance to nearest lot |inu''''-'''''-'''''''''-_'''__.-''''--'_-'__''--�_'''-_-.'�-_��' Rnmode|ing and/or repairing (doscribe):----------------------------._____--_-___---__-.__.___.___._-�_______ o ------'---''--------------'-----------'-----'----------'-----------------' | -''-'--'----''-'--'-------'--'''----'----'''--'--'''-'----'--'-------''--''--'---'''--''-'--'' ------___----___--__._--__----___-.__--_'_---.--___---__�__-_----..__'_-_-__-.. i ' hereby certify ^~' ' '~`. '^-p~'^~ Ais application and ^~' the ~~^ ~^ ~~ ~~~ ^^ ~~~~'~~'~~ ~^^ ~~' ~~~,~~ ~~p ^, - ordinances, State laws, and rules euH� ��' ---------------------- By.__ '--_-- ' '--------�.'-_'''''''-'-'�-'_- and/or Contractor) Bv._.----.-'----_--_----.-----.----------.---.-.------_----..-(Title)----.----_------------_. UPlofmlan. showing o6m of lot, |wnutinn of system in relation +owells, 6uY|6|ngm' o+c~ can be p|uco6 on ,evone side). FOR DEPARTMENT USE ONLY Al+n,wt/onomnJ/or ,wnommon6af ions:-------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------_-_----_-_---�_-__--.___-__...__'__'--._- . ~ ' _-_.-----''-----'---''''-''''-'''_'''--_'''----_'---''''---_----_'--_'--_-----__-_--_-__---- '—'------------'-----------------'-------'-------------------'---'---- -----,-�'---'-�-''---'-' ''-'''---'''''-''''--'''-''''''''''''-'--''-_'-_-- 401 1 :7 F|N/\L |NSPECT{}N 8Y�--��.��.��- Dufv-.�..��-'�.-��--�� ------_--.-- SAN JOAQU|N LOCAL HEALTH DISTRICT /30 South American Street 300 West Oak Street 132 Sycamore Street 814 worth "C' Streef Stockton, California Loa/. California Manteca, California rmo» California ' w ��/ ne,a^� v/�/uo � ^.-'-_^