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APPLICATION FOR SANITATION PERMITPer {n f- i. � <br /> � � -� <br /> � ""p"=�`�/ <br /> ~---.- Issued -.-^--.^-..' <br /> Applica�ion is,hereby made to the San Joaquin Local Health District for a permit to construct' <br /> d install the work herein'described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOR ADDRESS AND LPSAJION------ <br /> ---- ----- -- ' <br /> Contracho/s Name-------------)�j���1�� -------------------------------- -- <br /> InstallationwN serve: Residence rfmenfHouse E] Commercial [] Trailer Court E] Motel [] Other [] <br /> Number ofliving units: � Nu ber / <br /> nfbn6,00m, ' ,. Numberof6m+hv . _' Lot �h� --����.*�.. -------------------------- � <br /> - _ , _ <br /> Water Supply. Public systemmm�� system El 'Private E] Depth to Water Table ------- ft. <br /> Character of soil to a depth of feet:` E] Gravel r�vo| [] Sandy Loom E] Clay Loam [� Clay A6o6eE�-� r� Jpuo [] �- <br /> Previous Application Made: Yes E] No Construction: Yes ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -or cesspool permitted if'p4lic sewer is available 'ithin 200 feet.) <br /> (IN6.septic tank w <br /> Septic Tank: Distance' from nParest well A)).".?_.D1sfance fr V.Maferija--- --- ------- --- <br /> ------------- <br /> Disposal Fie Distance from nearesf well._A/�` X�)-istance from foundation---- - .-.Distance to nearest lot line---- <br /> Seepage Pit: Distance -to nearest well----------------------Distance from foundation <br /> 'Cos,poo|: Distance from nearest well-----------------Distance from foundation--------- --------- Lining mohe6nL -------_---- <br /> [] Size: Diameter.---_----------------Depth----------------------------------------------------Liquid Capacity-----------------.--------gals. � 1 <br /> / <br /> Privy Di�� ancr from nvo.reo well'-''''''����-''-'''-^'Distance from nearest building------------------------------------------ <br /> El _ Distance to nearest lot kne---.------^-.---._-____�.__.________________� _ <br /> ' . <br /> Remodekng and/or repairing (describe)-----'--''_-r'-'''-'-�'-_.',------------------------------.---------------------------------------------------------------- <br /> --------------------------------- '----'_-'_-.'--'''__.-'''-__.'--'--'''-_-_-'__.-'--'_--_''-''''_ ---------------------------------- <br /> 4 - <br /> -_--. _.--_-----_--.------------------- ----------------- \ <br /> ` - . --_'-------.__..___------- � <br /> —'--'-''-'''_-..-'---__'' ----__-'�- <br /> ' here6y certify that / have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State lawsland rules and regulations of the San Joaquin L*ww| H*mh6Disfric+r' <br /> , <br /> ----------------------------------------------------------------- <br /> (Plot plan, <br /> showing size of lot, loca+jon';Df system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ou/uu/nG rE <br /> Alterations and/or recommendafioqj_�__.:---- <br /> ----------------- <br /> 5 1 <br /> --' --'-r-^` ^~C~^ ' '~~^~ ' ~'~'~~' . <br /> ^^ <br /> /30 i��h Am��a sr°�' � �momes t Oak Street /mx Sycamore Street 814 w"*h 'C" Street . <br /> Stockton, California ~ Lodi, C°|*","ia � M""te=. California Tracy, C�|K"m� <br /> � °+ <br /> � <br /> _ <br /> ' �* -�- \ ^ <br /> ES-9-2 w` n°.a°a w�x/oo ' ~_' ~- ' <br /> _ _ <br />