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APPLICATION FOR SANITATION PERMIT <br /> in Duplicate) ' <br /> Application is hereby ado to the San This application is made in compliance with County Ordinance No. 549. � <br /> JOB ADDRESS AND LOCAT1ON_q/_"?71 - - --------- ----------------------------------------------------- ------------ <br /> Address_---''u-����..��-_.`��~�--'���L��'����--' -----------------'---'�--------'----------''-'---'' <br /> Contractor's Name_ ---------- Phone-___--_-_._- <br /> Installation will serve: Residence WApartment House E] Commercial E] Trailer Court El Motel E] Other [l / <br /> Number of living units: Number of bedrooms �� Number of �vtk, �� Lot ��'"���� ~ -~�^ <br /> } �r ��' �p '»'~< -'=�'--` 'p'��---'' ! <br /> � <br /> Water Supply: Public system E] Community system E] Private �� <br /> Character ofsoil hmadepth cfDfeet: Sand Gravel E] Sandy Loam E] OayLoomC|' y ' Adobe -/Hardpan [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) <br /> Septic Tank: Distance from nearest well -�-Distancefrom foundation' - ------ <br /> -' k -a+o,i � _���.�i <br /> No. of oumpur+menf�---- ---------Copocitv-4. Sizo -;6rd:r% ��.-Liquid depth.....1l... ---.-- <br /> Ce«,ppn|/ �~w <br /> ,. <br /> Dl�unce from nv�nyxfnuU-'_-__�D���no� {,omfovn6m+ipn----_-_L�n�ng material ---------_-_-- . <br /> . El Size: Diameter-_,.-----------------------------Depth------------------------------------------------P�: D�� fromnearest �K Distance fromnearest �i�|n� -_'__.4�4 - <br /> �] D�+unoatv nearu, lot One.-���l�--.----------.- � <br /> -Seepage Rt: Distance to nearest welL__.-..__'Distanon from fdun6ufion--------------------Distance +o neunauf |o+ line-_-_-- <br /> U Number ofPits----------------------Lining material----------------------- Diameter-----_..__-_Depth ..__--___.. <br /> �Di | : Distance from neare + well -%60----.Distance from foundationDistance to nearest lot <br /> Q�~~ Number of line� � Lv �� ofo*c� ||nu.. Width o[ ��nc�.-_�� '--.-_-_ <br /> ' Type of filter maepfh of filter material ' _- <br /> � <br /> Rem deling and/or repairing describe):------- l <br /> ' L� � ' ------''' <br /> --'^� ��--'-�,-�--��___..zF-F��xr��-� _t <br /> .�._____ <br /> [ ----''---------'-------'--''---'-'--'---'--------------''-------------------'''----'—'-- <br /> hereby-'__ ''-_-'-__-''___'--'-_.'''-__'''--''___-''_-__-'-_.'___-__.'--�' <br /> ordinances, State laws, and rules and regulations of the San Joaquin LocalA-iealth District. <br /> (Plot plans, <br /> 5 0 ing size of lot, location of system in relation to wells, buildings. etc., must be filed with this application). <br /> _ <br /> A,,yFDEPARTMENT USE ONLY <br />^ Alterations and/or recommendations:---------------------------------------------------------------------------- ----------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------'----''----'---'-''---------' <br /> .___.__--.___--_-__.'.___...___.--_--_-..__--__----__-.___-_____.__.-__.------____-_-._. <br /> ��--'--''-'-----'--'-'-----'--r---'---------'---'----'-'--------------------------' <br /> -_'__^_.--''---__'-_-''__.''_-.' -'''-�.-''----__''__''--''__.'�''-__-'---''_-'--. <br /> PERMIT No.�?'���1--------- ISSUED-------^�.. --_(Do+a) FINAL INSPECTION .-.-------____ <br />. Du+�_.-.----��^�..- _ __ <br /> � <br /> SAN JOAQU|N'U]C/4LHEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br />�� <br /> ES-9-2M 9-50 vv'1639 <br />