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` �o ' ^mr APPLICATION FOR SANITATION PERMIT 4/ Permit ��m�|�fe ;n �m�|��fm\ ` ' Dote |ssue� -~x^�'��--^^ ' , cJ 'is hereby d= to +h Su Joaquin Local Health District for |+ to and install +k .or hlescribed. T 's application is made in compliance with County Ordinance N 4-9, 00 JOB ADDRESS AND uuCA//c/m 4;�, --.'�'�. x~` °m��`--/.urx�x*�-'xx:m�..�-----'��..��-J�..y^']4u---. | Owner's Name-_.--------�� -' --��&---n--,----- ---------------------------------------------- Phone-------------- -_-----.. A6dmos- Contractor's Name--------------------------------------------------Q 4-t-�- --)--------- P- e- Installation will serve: Residence)o Apartment House Commercial E] Trailer Court [] Motel Other Wafer Supply: Public system X Community system Private [] Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam F] Clay Loam 11 Clay El Adob Hardpan E] Previous Application Made: Yes E] No X New Construction. YeS4 No.M ' '' ^ OF INSTALLATION^ AND ~' ~~^ '~~''~'`~' ` (No septic tank or cesspool permitted if public sewer is availablewithin 200feet) -. Septic Tank: Distance from nearest well �� Distance from foundation191 Material No. of c ---Liquid depth C 91-- Di,p000| Field: Distance f || yWL� D f foundation- B� 4Distance to nearest lot || r �� Number cJ |i Length f h |i ��9� �N�VVi6 � o{ � .�9�� ^ » Type of filter mvferioL..�.g�'.---Depth of fi|+nr motorioL-'`k��L.-Totu| length � Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance +o nearest lot |ine-6-0--. / [] Number of -_, -----------Un|ng material----------------------Size: Diameter-._------------Depth----.__._-- �»�� Cesspool: Distance from nearest well ' -------Distance fnzm foundation- Lining material -''''-'_---''-_ [] Size: Diameter-------------------------------------- ------------------------------ ---------------------Liquid Cupucity -----------------------gals. Privy: D�st nca from nearest well ''--''-''-'''-''--'—Distance from nearestbuU��----_-'--'_--'--- [] Distance to nearest,lot line--------------------------------------------------'--_----- --_-_____._._-'_--.-='.—.. . Romo6el|ng and/or repairing /6os �be):---'--'''-''-'' '' -_.--------------------------------- _-''--__-.--'_ __..____.___--_-__----__--__._'-- ' | ~=" "r """' | hare p' `~~ � ordinances, State laws, and rule and regulations the San Jo'aquin Local Health District. (Plot plan, ong we of °t, ation of syste el io to wells, buildings, etc., can be placed an reverse side). FOR DEP mm|xxEx| USE ONLY APPLICATIONACCEPTED ~'-------------------------------------------------- ---------------------------- ---- ~'^^----------��'~~ °-''`~' --- - REY|EVVED BY--------------------------------------------- --'_-'---'-��..��'--''--''---'--. DATE-''' -i''-'-_''-'-_-___.-' BUILDING PERMIT ISSUED------------------------------- --------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations __----.--.__..__._ Alto,m+lonsmn6/or recommendations:--------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------—'—'-------'--'----'-----'--'---'''---'- -'-'_-''----__''-'-'-----''_--------'-_''--_'''_-'-_-'-_.'--'—_--_-'--'--'-_.''-'''_-.'_-'---' '------'--------'----'--------'----------------'------------------'---- ----.'-'-''-''',-'--'- ------------ ��_�'�—''-'''--'''--''-'-'''--''---''-'---'-'------ ----------------------------------- FINAL -'--''--'-_FIN/\L INSPECTION BY:--- -------- �.�--.�(��./��~<,��, Date ---..- -Y---------------__.- SAN JOAQU|N LOCAL HEALTH DISTRICT /m South America" Street 300 West Oak Street /32 Sycernore Street 8/4 North "C" street Stockton. California u,di. California wanwma, California Tracy. California