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'a <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> � <br /> . � � <br /> ��� ma� � �o �nJ�qu|n ��| Heu� D���ra ��� �c��� �d ��aU �ewp� �r� des�6�. <br /> T�� application is made in compliance with County Ordinance No. 549 <br /> JOB ADDRESS AND LOCATION------------------------84 8 B ---Ave._ .__________--___. <br /> Ovner's Name------------------------------------------Ern-i/y--Go�na--------_-_--�-_-.--_---_-_---. phone- li-----.-- <br /> Ad6m,,-----_--_.------_- So.-'Sl��rr�__IJ����euI6' .______.. ----------------------------------------------------------------------------- <br /> Contractor's N�me_______ Z)°�*_Parish_6b_8.g-n--.�.x_Z�� <br /> --- - -------------------------------------- Phone---- Z-------------- <br /> Installation <br /> ___|nsta|lationvill serve: Residence [N Apartment House F] Commercial 0 Trailer Court E] Motel L] Other E] <br /> Number ufliving units: D] Number of bedrooms ELI Number of baths []j Lot size----6_0---X---11ql--------------------------------- <br /> Wafer Supply: <br /> -------------.-'VVaferSumoly: Public system M Community system F] Private E] <br /> Character of mxU to 6apA` of feet. Sand [���Gruvn| E] S�ndy Loam El^ -,|oy Loam 0 , Clay E] Adobe [� Hardpan <br /> TYPE CJP INSTALLATION AND SPECIFICATIONS: ' <br /> (Nm *optic tank or cesspool permlff*6 if pu6i;n sewer i, available within 200 feet.) <br /> Septic Tank: Distance from neore,tweU-_-----Distnnce from foundation-------------------Material _-.---.--_---_-_---- <br /> [] No. ofcompartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth_--�----- <br /> Ceopoo|: Distance from nearest well-----------------Distance from foundation--------------------Lining mufe,iui------.-----_._�`�� <br /> 11 Size: Diameter--------------------------------------Depth_--__--.___-..____ <br /> Seepage Pit: Distance to nearest well----------------- ----Distance from foundation--------------------Distance to'nearesf lot line----------------- <br />' ~'^'~~ ' Field:^ \ Distance from ^~~'~~' Distancecfrom '°°~°ation----15-_ '--D=a'"= to '="'""' "o' ==--^--- <br /> Number of | of each Width oftrench '_�4.11---------------------- <br /> . Tvoe.offi|+v, ma+e6n| C-kDeof of filter mna+a,iuL..�1��"---- <br /> - .&��i�� I I�r��� <br /> Remodeling and/or on6/o, rapu|�ng 6desc�6e .---'1�-..-'�-_-----��o�� � _,.___________________________. � <br /> � <br /> __--___._._____._____.___---__-___-------.__-___--.__--..__.'____.-- � <br /> ______.-___-_--_----._-____-..___-___--_-_--__.-__�..--__._-'___ �--_---_-__--�-� � <br /> ~ <br /> ' mf | �ova that *or will d ' <br /> I in accordance with San <br /> mnJ�a State laws, n6 �m and regulations of the San Joaquin Local Health Joaquin 'i� <br /> (Plot ow; g size of lot, location of sysf in re ion to wells, 6uildings, efc., must be filed with this application). <br /> - <br /> . ~~ DEPARTMENT~ ~~E .~.=^. , <br /> " <br /> APPLICATION ACCEPTED BY------------ DATE <br /> ou/LuxN�� PERMIT ISSUED_-'--_-'-__-'''--.-_'--'-_'-'-_.--�-_.��''--' DATE_-'_�-_��__.�''-''-_____�_ <br /> Alterations and/or recommendations:-_.--__-----_----___-_-._.___._-______---'_-.---'- <br /> --_-.-_.___-__v__ <br /> .--_--.__-..__.__--__--__'--___..__-_-.__---__-_____----'--'_--.--------_--.__--_.-.|-.� <br /> _____.______..______-_____.____�____.____.____.___--____.______.______.________'_--..l | <br /> / <br /> __.__._-_-_-'-_�.''_-.'-_.'''__-'-_-''__-''''-'--'--__----_-''--__''' � <br /> _____________'________________________________________________________ <br /> up� �� <br /> PERk4|TNo..^v'��--_-. |33UED-'1/��!�[..�.=--_---(Du+v) FINAL INSPECTION BY:---------------- <br /> Dat�__-___'-�_-'_. <br /> SAN JOAQ0NLOCAL HEALTH OBT0C7 " <br /> 130 South American Street <br /> Stockton, California , <br />� <br /> ES-9-2M 9'50 w^1639 <br />