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APPLICATION FOR SANITATION PERMIT (��onxp|�f� �n �up||*afe1 ^ ' Application is hnn*6v mode to the San Joaquin Local HeaA DistrIctfor a permit foconstruct and install the work herein described. This application is made incomp/ionce with County Ordinance No. 549. ^ JOB ADDRESS_ AND ----- -------------------------------------------------------_-_'- uwnr m ----------------------------------------------------------- Phone------------------------------------ Address Z.3— -------------------- ~ ~ -�� '�-''-'--'---''-_'�''��'-'__. � _-'_-'--_-__''-- |nsta|lationw|U oorvm: Rusidence�� Apartment House �� Communcio| [� Trailer Court El Motel El Other El' �ALot ° * Number ofliving units-. Number of bedrooms �� Number ofbaths Wu Lo+ ,�e. -� ----------------------- Wafer Supp ._--_-'VYufe, Sunoly' Public system A Community system M Private [-1 Character of soil to a depth of feet: Sand E] Grovel E] Sandy Loam Ej Clay LoomEl [1uy �] Adobe�� Hardpan [j TYPE OFINSTALLATION AND SPECIFICATIONS: (Nm xmp+i� tank or cns�p��| permitted � pu6|�� ye°er �sa°aUa6|ew��n ��Dfnet) * � ` - ^ Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ------.-_---------.- ' 0 No. ofcompartments--._--_-Capacity-----------------------Size-------------------------------- Liquid depth-.--_---. -' �Cosspoo : Distance from, nearest well------------------Distance from foundation--------------------Lining material --.------._-- u F] � Size: Diameter -_.��-''''----Dept 6 Privy- Distance from nearest well ---_-��--.---._..Distance from nearest building----------------------------------------- El Distance to nearest lot line.__'---'''_---'��-�'- P Seepage Pit: Distance to D � 0.� Di neana� lot |in�-n�14------- 4. - ~� � �Num6er of pits _� Lining mo+or�LC"� Diameter--- Depth �Disposa| Field: Distance from nearest weU------------------Distance from foundation--_--- Distan.ce to nearest lot line.--_- El Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------------ Type ---.''--'---'--'Tv9v of filter material .---._--Don+ of filter material --_---. 'Remo6e|ing and/or r�z��g (describe): / � ' ` -` ''-�''''�(''-----'-�^ -'--^- ^�^~`'^~��^''''''''''--'--''--''-�'--'--' '—'--------''------------'--'---------------'--'---'---------'---''--''---'---`'- ---__-_--'---'_-''--'-_--''�-__---_'--_''---''--''�-_.--''----'___-''''_--__'''-_''----__----_. .-_--_---__-_-----_-----__-----------_------_-.---__-----.-_---_-__-___-_- | hereby certify that | have � applicationprepared this at the work will be done in accordance San Joaquin �� o,6imanoa». State �ws and rules and ,ogu��onsmfthe San Joaquin Local Health District. '|� ~�. �� (Signed)- - �-- ��------------ ---------- `___ ....'~. ~~...~~./ �c ---------- --------------------------------------- _____.. U"lot plans, showing size of lot, location of system in relation to wells, 6uUJings, etc., must 6e filed with this ap L ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y1^ } /� DATE ---��--' 1�'' ---'--------'-�-�-'' --'��-~=* rf'-'��'--'' REVIEWED BY--__--.----_._---.---_-��--�---- ----.------.--- DATE----��----.---_-��-�.--__.. BUILDING PERMIT ISSUED----------------------------------------------------------------''''---''''�-- DATE�''''_-'-''-_.''___�______ AKe,u+ionoand/or recommendations---..-._---._------__---_��_____--___-----___________ _'_�-_-__''_-'''''--'''_--''''----''--�''''_-''''--_'''-----''-__-'''''-__'''----_.--'-�.''-----. '----------'--'-'----''-----------�---------------'--------------------'--------'' _____________'________��__�__�__'________________________�� ------_____'______'___'___�____________�__ __--___-._---'_-__-_-----------------------------------_------_---'_--_---_----_-_-__- � h? PERkx|T --' ISSUED'..- ------------/Dafe) FINAL INSPECTION BY:. ----------------------- Dufe'''--'''' . SAN JOAQU|N LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M v'so vv'/mp