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APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />~~ � <br />gplicafion is hereby made to the 3un apo,m�tocon,�ucfun6indaUfha�or kwm:�n6es �6e6. <br />/n/,application is made in compliance with County Ordinance No. 549. <br />JOB ADDRESS AND LOCATION ------------ -��----------------------------------------------------------------------- <br />�au_ -----------��--------- ............___ <br />Installation will serve: Residence B--A-'partment House Commercial [-] Trailer Court [] Motel E] Other <br />Number of living units: --- I --- N ber of bedroornsl- Number of baths __1---- Lot size ------ ----------------- ------ <br />Water Supply: Public system ;�?Zunity system [:] Private F7I Depth to Wafer Table -------- ff. <br />Character of soil to a depth of 3 feet: Sand F],_Grra—vel [-] Sandy Loam E] Clay Loam Clay E] Adobe R--�ardpan 0 <br />Previous Application Made: Yes F� No PI -_*'New Construction: Yes [:1 No 2-FHA/VA: Yes 7 No E��� <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No se2fic fan6or'cesspool permitted if public sewer is available within 200 feet.) <br />Disposa,l,��. Distance from nearest well-S-O'f 4W <br />- - Distance from foundation --/Z 7 ------- Distance to nearest lot lino .......... ...... <br />_1R1117` � Length. / 1.2- Type of filter "".v,.".l^a�����`* uupm of filter mo'enu/ � <br />[] Size: Diameter --------------------------------------- ---------------------------------------------------- Liquid Capacity -------------------------- �m <br />Privy: Distance from nearest well '--_---_'--------Distunce from nearest building -------------------------- ' <br />' ^omooe/ng and/or repairing (describe): <br />---­------- - -------------------------------- - -------------------- -------- - 0. �_ ----------- ----- ------------ <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulaA!*p"if the - San Joaquin Local Health District. <br />By: _). 1A --------- ! ------------------ ------------ <br />(Plot plan, showing size of lot, lioca n s s-�eiiin relation to wells, buildift9ii-vtc." can be placed on reverse side). <br />FOR DEPARTMRjT USE ONLY <br />APPLICATION <br />RB/|EVVED <br />DU|LD|NG PERMIT ISSUED ---------------------------------- —_'�^��-'___-- <br />AJ�,a�onsand/or ,ecommnandmf�no.--.^--.-y��--.---------------- <br />--------------------------------------------------------------------------- <br />'---------------------------------------- <br />----- <br />----------- ---------- ------ ~'^^-- —/ <br />------------'—'---7'-`�-------------'-- <br />--------'--------------------------------------------------- ---------------------- ...... ...... -----'----'-----'------------' <br />_--__--_---_--___-_--_-_—_--__—__-__--___'_-___—__—._____-__—_—_--_—._' <br />—''-------------------------------- <br />'-- <br />RN/\L INSPECTION BY�—���.�������.{ Do�e---.�.-±�--_.`��---��..or�_--.—_ <br />SAN JOAQU|NLOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California n**» California <br />