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FOR OFFICE UAE; <br /> xe <br /> ..... - <br /> � APPLICATION ��� 'SANITATION PERMIT Permit No. <br /> (Comp���o�; � 0up���� <br /> lete- ^ Dmhm /x*ue6 <br /> Application is i* hero6w nnn6e to the San Joaquin Local H*o|H` District for m permit to construct and install the work hnno|n described. <br /> This application io made /ncompliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..... U24 0 ' <br /> ----------------------------------------------------------'....... ............ <br /> Owner's N - - -- Phone_................................ <br /> Address <br /> --' <br /> Con�ucfo,s Nomo-._-. -���._-_ ------------------------------------------------------------------- Phone............................. <br /> Installation will serve: Residence Er Apartment House F] Commercial [] Trailer Court 0 Motel [I Other [3 <br /> Number of living units- y-.- Number of 6o6,00nm 2- Number of buf6 _!.- Lot size IFIA. .'6 *................... o� <br /> Water Supply: Public systemC5--Community system M Private E] Depth mWater Table _- ft. � <br /> Character of soil to a depth of 3 feet: Sand [] G,uvo| [] Sandy Loam [] Clay Loam [] Clay [] A6o6nffl-HanJpmn Fl � ^ <br /> Previous Application Made: (if yes'6ote---------- Nue~~~wewConstruction: Yes E"~~Nn [D FHA/VA. Yes 25--No El \ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> /(�� sm��� tank �r ���p�m| pm,nmH+�� �fpu�K� �m°�r YomvmU�6|mw��\n 3�� fwef.) <br /> ` <br /> Septic Tank: Distance from nearest woU..����--Distance from foundation-1A----k4 ,imL-..[��..��vw�o�_v�---.. <br /> ne^�- No. ofcompa�mnan�-�2 -----..Size-_ -U <br /> .��.��[����^ quiJ � -- - ---- <br /> op�� �� / /�upod+y ��` <br /> Disposal Field: Distance from nearest well---—-------Distance from founclation._A�_(...........Distance to nearest lot line-- ...... <br /> Number of ^'~^-- ~~'y^' of each ^line-�"-~~'''''--'``'""' of trench''°�^^`'--'-'-'' 1 <br /> Type of filter mote,�|W --------Depth of filter nm+eria|���+--_Jotu| |emm+6- jo/--_.--'_.Seepage <br /> ' � <br /> : Distance to nearest |L �__D�� to nearest lot /���_- <br /> ��- <br /> Number cfp�o'-_I_--�n|ng mu+o6uL~- . Size: Diameter_';x3_v......Depth '-. _--- <br /> Cmsqaoo : Distance from nearest well --' ...Distance from found m+iom Lining mu+m�a| <br /> ---r---- -----'----- <br /> [] Size: 0iamm+oc '---'-''---_-Doot6-_-''---''-_''--''--.-Uqui6 Copocih�'--__-'-'--gu|v. <br /> Privy: Distance from nearest well---------------------------------------- -------Distance fnmryi- nearest building.------.___.--_ <br /> [] Distance h, nearest lot line <br /> Remodelingun6/v, repairing (devcr|be):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------'—'--''-----------------'----'--------'----------------'- <br /> --''-----'--'''-'---'---''------'-------''--'''--'---'''-----------'''--'-------------'' <br /> '----'----------''--'-----------'----''---'--------------'---'-------------' <br /> | 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 regulafions; of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location s s elation to uildings, etc., can be placed an reverse side). <br /> �L ----------------------------- <br /> FOR uErAm/xxEm| USE ONLY <br /> APPLICATION ACCEPTED BY-0— <br /> Alfv,rati_� � /}and/or recommendations- <br /> /,.�-'''- -'- -��---'r -�\ /��''-- '''-'-''---'--' <br /> �-=_--''+�^w^- '' '�x»^�.-'��^p�'_ _�� ___._______.__.---- <br /> ---__--.__-__--._------------_----'--_-..-^--._----_-_-- --------------- <br /> --'''-'--'-''------'''- '''--'''-'''-'''-'''-''---''---------' <br /> RNAL INSPECTION BY:-.� Dote-.- / �-��- �� 0 -~- .^��- -------------- <br /> )SAN JOAQ0NLOCALHEALTH DISTRICT <br /> 1x0South American Street xvvWest Oak oif°et 1u*Sycamore Street zwsWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES REVISED u'sycw 5-62 ATLAS <br /> . ' <br />