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� APPLICATION FOR SANITATION PERM[[ p�omo�� Dup|�a�) ~4�' Application is hun,6y made to the Son Joaquin Local Health District for u permit fp construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. . �x° �� JOB ADDRESS AND U]CAT|[}N----��..~��_-'�.',- ------------------------------------------ Name------j -----------_-.__.- Phone--- ---------- 3 __... �Jd�o�'___-��-��_�'_��"- -''-------------''---------�--'-'------'-----''' �=. �� Phone ' Con+mc�,/s Name`___�-.�_ -----_---'_----�-----_-_-__-..__.__ ne-.-"��-�. |nstallation ,ill serve: Residence E] ApaHmenf House E] Commercial K Trailer Court 0 Motel E] Other Ej � Number ofliving units: Ej Number of bedrooms E] Number of6u6s0 Lot size-'-_-- �__-- . Water Supply: Public system [] Commundysystem El Privmte & Character of soil to m depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [] Clay E] Adobe E] Hardpan [] ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � Septic Tank: Distance from nearest .eU-'^��/--�Distance from foundafinn'�_.. ' L-��/�� -.---_� 10 ` No. nfcompartments--------~�!�-----------Capacity---------�-------------Size------- ^I~~'Liqui6 depth -_��.^'--- � 'Cesspool: Distance from nearest well-----------------Disfan�e from, foundation--------------------Lining nnaturiuL.----.-----.-_-_ n Size: Diameter------------------------------------Dept h____-----_____----.. 3Privy: Distance from nearesfweU-------------------------------------------------Distance from nearest building'_-'''---'__.-_''-' K�� R Distance to nearest �of line------------------------------------------------ Seepage __----_-_-_----_-_.-5uepuga Rt: Distance to nearest wu|L_---'-_-Distunce from foundation--------------------Distance fo nearest lot line----------------- Number of pits -___'- Num6orcfpits----------------------Lining mu+°r�oL_--.__'_Size: Diameter..___...__-Depth--..____._._ Disposal Field: Distance from nearest wa| Disfanoe from foundation W..,--Distancm to nearest |o+ line---410-"---- Number of linesLengthof each ||n�_.. Width o' f �nnc6_-ZL# �,-�-�__ --- Type of filter mu+a�o|.I��% m*� Deo+ of filter material-------- -----'-' ` ~~^~~~^'^, ~ --n ---'''�------''-------' '�r^- �~-'^~'-- �---'*"-----�-----'---'--'—'--''---'''--'—'-----'----' -----'��---------''---------'----'---------------------------'��-----------------'----------------------------�'��'��'� �-�'-'''_-''''-'___�_'-'__-'___'�--'-___'''''-'''`-.'','---_.''----'''''�''_-__.-_.'___'_-'''-_. hereby certify that I have prepared this application and that He work will kedone accordance with San Joaquin County Joaquinordinances,/Sf�fe I�ws. and rules and regulations of the San � XZ) --------------------------------------------- and/or Contractor) ___�___.._______._____-----------------------------------(Title) showing size oflot, location of system in relation to wells, buildings, etc, must be filed with this application). FOR DEPARTMENT USE ONLY � BU|LD|NG PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-_--------__-_-------- � Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- ---_.-_.--------------.--_----_----_-------_--.-.------�-----_-----___--_-----_---_------_-- 1 ------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- '-----------------------------------�-----------------'------'-------'-------'- ---_'-''__'''___''' ''-_---'''''''-__'-'-_--''�'�''__.'''��_'_---_'- � | � � PERMIT Nn-.x��..x_- ISSUED------ -__-(Du�� RN/\L INSPECTION BY�._----.-_ Date *� ~� � ~ �--_.__---u� ,---____.- SAN JOAQU(N LOCAL HEALTH DISTRICT |30South American Street Stockton. California ES-9-2M 9'50 w�/asv