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d) <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> v 0 Fk\ = - (Complete, -`^ <br /> &n <br /> Duplicate)' Date |ssu �/ <br /> � hereby the Son Local Health District for o permit to construct and install the work herein described.described.described.�Y-. <br /> Tso� �o+�nismuJolocompliance <br /> � <br /> with County Ordinance No. 349. <br /> JOB ADDRESS AND LOC <br /> '------ -' '' -' ' - <br /> Owner's^ --------------'~^~ <br /> - }, - - - ---''--'-''-- ---'r--'-----~~'' <br /> "vp.e,s.--^ ._�_...______.__ <br />. ~~ ^'~^'~ ^ '`~^�-^-e�'^~+�=^ -` = ----------------------------------------------- Phone_'---_---.-. <br />� |nstaUetion will se;"e,^Ro,|6enon Apartment Hvmu, E] Commercial E]-TFailer -Court [] Mote [] {Jtko, F . <br />' ' Number of ` unit,: ~{-. Number nfbedrooms � '. Number of boHo .. /.- Lot size --' .~~ <br />. Water Supply: Public system Ej Community system El PrivateD � � ��r . 6| ' � ft. <br /> � <br /> �� ' <br /> Character of soil to depth of 3 feet: Sand F] Gravel Ej So�� L�� [� �� Loam � Clay � /��� �� Hardpan � - | <br /> . �� _ -- . <br /> Previous Application Made: Yes E] No REƒ, New Construction�°Ye, [:] No F] <br />. <br /> TYPE OF INSTALLATIONAND SPECIFICATIONS: / NN <br /> (No septic tank or cesspool permitted 7fpublic sewer isavailable within 200 feet.) <br /> Septic Tank-7/' Distance from nearest we --Distance from foundo+ion-/'<---�-Motn,ioL-.. ----- <br />~ No. ofcompu,+nnonts--.._��---..3izo--_-_----.--Liquid' 6 h C <br /> ' ��-d -- <br /> Diisposal,ylidl-a: Distance from nearest we1 -------- - -D�stance from foundation--- Distance to nearest lot line_�_-_�----------- <br /> Depth of filter material------ ^ length ' . <br /> Seepogo Pit: Distance to- nearest well '� --'''_'-Distance from foundation----------- '--Distancrfo nearest lot line----------------- / <br /> [1 Nu��6aroFpH�---.-.._~~L|ning material----------------------- Diomotvc-------.Dcpfh----------.. <br /> � - _. ~__' -__�- <br /> Ce�apoo|�` � � � ^~�isfunco from n��ro� xm|L__-..Di��nca6om {oundv6"n------'Un|ng material --.----._--- <br /> [] . ---- Size: D�mate�_,_------'---Dvpt�'----=_...__-----__-�L�ui6. Capo�ty -_-.~...----o�� <br /> Privy: Distance.Irom 'nearest well ''''--'''-''''-'''_.Distance from nearest building'��-'''-''--'--'-- <br /> El Distance to nearest-lot line.. <br /> 01 <br /> Remodeling rapoi�ng o\�'-_ �' ----_��--."�~^',-..`�,. .--.__---.. ' <br /> -�. � <br /> --''----' t--'--''---''---'-- <br /> I hereb� certify that-r I h�ve prepared this application an� fhat'the work will 9-e-done in accordance with San Joaquin County <br /> ordinances, State laws, and'rules and regulaflons of the San Joaquih,Local Health District. <br /> (Plot planAiow;ng 'size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> P FOR DEPARTMENT USE ONLY <br /> ------------ <br /> ------------------------- <br /> y----------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- <br /> - <br /> -----------------------------------------------------------'-'''-'-'''''-'''''' --------------------------------------------------------------- <br /> '----'4-' '-''' --''—''''----'---'--'-''�''-'-'''-''''-''' '' <br /> / ' -_-''_--'--_-----''-'-_''---. <br /> - --------- ----------- .------------------------------------------------------- --- ----'--.---_------------------------------------ <br /> FINAL INSPECTION BY;-'''`��.�w~' -._--/4Date ------------------ - ----------------------------- <br /> � <br /> SAN JOwkQU|NLOCALHEALTH DISTRICT <br /> /nn s^"m American Street amWest Oak Street m: Sycamore Street ow w"*h "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> ES-9-2M .0'52 xv,uo6 vv'z|oo <br />