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A - -- <br />�p�����lC��� FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicate) <br />at Issued <br />— <br />� <br />Applical-ion is hereby <br />^ San Joaquin . . ` <br />uct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. / <br />Owner's Name ------------ I T -a -C -0-b ------------ Vr ------- 24/6-/ P h o n _�vzy 64 <br />Addres <br />---------------------------- <br />Installation will serve: Residence [�—�parfmenf House Commercial E] Trailer Co'ur'f F] Motel [3 Other <br />Number of living units: Number of bedrooms )<'*"Number of baths _/--- Lot size --------------- <br />Wafer °"ppv' ^""'c`"p=" m�C"m,="y ,y,",m E] Private [:] Depth to vvore, mblo°��O ft. � <br />Character of soil to m depth of feet: Sand EI Grave E] Som6 Loam [] 2^_M <br />, �=~�^ m -- <br />Previous Application ��odo� Yo, [] No �� NewConstc+ion� Yo, DNo El' , - <br />TYPE OF INSTALLATION AND SPEC|RCAT|ON5: <br />(No sepMctank'w, meoq,mo| permitted if public sewer is ;vailab|owith|n 200 feet.) 4 <br />S Distance from nearest well <br />Distance from foundation'------------------- Material .�--------_--- <br />Nn, nfcomportmen+s------- ---- —---------- Size ---------------------------- -..Liq:iJ depth --------------- <br />---------- Capacity ---------- ------------ <br />D Distance from nearest .-�eU��----.D�f Distance from founduf�n—_----Didunce to noum� lot |lne-'__'—_ <br />Number of lines ----------------------------------- Length of each |ino_--�---.---'Width of french <br />Tyl'e-ofpfCte' <br />Soo : -- .- Di�f��; - ^^ to nearest lot k ~- <br />�z~~- Nun6orof p��——��—~~-~Tiing mo+e 'S�o: D� *--- Depth ^� � / ' --'--''—' K\ <br />|� Di,h,ncu fn,m no°n*�we|L,'''_'''Di�ance�om foundation-~_-'''—U�ng mo+eduL--'—''—'''--'_ <br />[] <br />Size. Diameter .—.+--------'Deof _-----­.�_—_-----_Uquid Capacity ---------------------------- gals. ^ ^ <br />Privy:.� D�f nca from nearest we|L'''—�''—''—_'—''�_�'D�f "m» from nearest building ___'_—'___—''___ <br />��� ��� 'Didonos to nearest |o+ <br />Remodeling and/or repoir�ng (describe): --------- ------- ------------------------------------------------------------------------------ .____ `________________ ' \x <br />_____'__'______�________'________'______'______________'________'_____�_______'____ <br />' ^ ` --_----- <br />'—''---''—'—'----------------'------''--'--''---'--'-------''---------------'' <br />. --.__---- <br />|ance ` <br />1. <br />,(Si,.—�_ --____—_ounty <br />-__ Idegulafions <br />11 ady�x Contractor) <br />(Plot plan, showing size of lot, location of system in relafi to weiis-_,_ ull <br />' <br />FOR DEPARTMENT USE ONLY <br />----------------------- <br />-------------------------------------- <br />� ��~ <br />�N/\L-|N3PEI�T{}N-BY.: -'�-.—.-.�)�('�..]�K���^.�}�o-_— ' - - D**�--_--�.--z.-J-^_.^��'__—_____._.. <br />SAN JOAQU|N LOCAL HEALTH DISTRICT � <br />130 South American Street 300 West Oak Street /32 Sycarnore Sfreef 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />sS-9-2w� Revised W-2100 ' �� <br />