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��z2�� t �~~- ��r� APPLICATIONFOR SANITATION PERMIT Permit No. - ��r (Complete in Duplicate) -- Dufo |o,uo6 ---- Application is 6ona6v made to the Son Joaquin Local Health District for u permit to construct and install the work herein described. This application /s mu6o in compliance with County [},6inunco No. 549. � �~� �u�� J[)8 ADDRESS /\N U] N---..----------- �~=^�-.. .��-�3��!��-------------------------------------------------------------- Owner's .'.. .----' --.. - ...... ---^5.F _____------__-----� Phona.��.-��.]0�.�� '~~'~^^---- -~~ ^---'~^�~ ~~�^r~~~~^'~~---'--'------------- '---'---'---'-' ------------ Contractor's Name-_-. -------------------------------------------- ------------------------------------------------------ -------- Phone-__--__----- |nsta|lationwill serve: Residence W-ApartmentHouse E] Commercial F] Trailer Court [] Motel 0� Other [] Number ofliving unit,: � 2-- Number of baths /.- Lot size -50- m^ .. � / -`�---_' .ymWater Supply: Pu6||v systemCommunity system E] Private F1 Depth to Water Table ft. Character of soil to w depth of feet: Sand [] Gravel E] Sandy LoaClay Loam [] Clay E] Adobe Hardpan E] Previous Application Made: Yo, [] No g?" Ne* Construction: Yes t8"No E] pHA/VA. Yeo E] No 24-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No oapf|o fank w,wesspnp| permitted if public sewer isavailable within 200 feet.) Septic : Di,+onry from nearest well-NOtIE-' Distance from foundation^ Material | «--mNo. of compurtnenh--.,;��--.Size- .� � -Liquid dep+h ----..Cupao^ y-..9- . .. IN Di, |d: Distance from nuanodwuU.&O�E� f foundation lot Number of lines - ~~ Length � each |�n� ��5- Width of trench Typu of filter ma+orioL-jq0C,X-4%''Deo+ of filter mn+er�°------/0...-]o+ | length-'-',1461-5-------------------- Seepage �t D�tonce to nearestweL''-'''-'-Di�ano: from fuun6at�n --'____-Di�ancetoneonetlot |�e'''---' ' Number of pifs----------------------Lining material----------------------- Diameter__----------Depth------ ---_--- ' Cesoon. Distance from nearest well ,'-''''-Oistancofrom foundation '-''-��Lining material -�''-'�'__'.--_ � El Size: Diameter---.--------�-----�---�Depth--'---._----._---.Uquid Capm�t^'----_-.ga|s. Privy: Distancefnzm noo�u weU-_-''-'''-''--_'''--Distance from nearest building'''--'''-''_-'--'- K�^ [] Distance tpnearest lot lire---------------------------------------------------------------------------------------------------------------------------------------------- � ~ �� . Remodeling and'/or repairing (describe):------------------------------------------------------------------- .__-___---__._------------- I hereby certify that I have prepared th* icafion and hat the work will be done in accordance with San Joaquin County ordinances, S, 'e laws, and rules and regulations of the San Joaquin Local Health District. _��___-_--__--__-'��-''''----''---'-_'----_.'---_.''� '��-'-'''�-''�-'�� ------------------- By: . (Plot o|un, showing size of lot, location of system in relation to wells, 6ui|6ingo, etc.. can be placed on reverse side). FOR DEPARTMENT USE ONLY BU|LD|NG PERMIT ISSUED-------------------------------------------------------------------------------------------- --------- DATE--__----_----__-_-' AKenationomn6/or :-''-_-''-'-'-''--''''-___--'''--�-''----'''----'--'---''-''-'-_.---' -_---_.----_-__----._-_------.------.--__-__--._._--'-_-.---_-__-----_.__.----. ---'- -_.''''-'-'''--''--------'---'---___.''--- -_-_ __-._--.__-_-_--'_---_._._.- -''--' ---'''---'----''''-''''-'-''-''-'---'-'--- /� RN/\L |NSP -Q'-`� Oo��--'*��._-��.-��. ---_--_---- SAN JOAQU|N LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak $=+ /32 Sycamore Street 814 North "C" Street Stockton, California Lodi. California Manteca, California Tracy, California