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p ` <br /> A APPLICATION FOR SANITATION PERMIT Permit No <br /> � C��c-�m <br /> (Complete- - Duplicate) Issued -.-7-/ <br /> - ----- <br /> App|co+�o � ham6vmu6e *ztha3unJouquinLoca| Heo|fhD|�r��foru � +o 6 U +h �or 6 6asc,6o� <br /> Thio <br /> application is made /n compliance with County [>n6in�nca No. 549. <br /> ` ^ ' <br /> JOB ADDRESS AND .���z= /� ���� /{��. --.�� a����.' ._----._____.-.. <br /> [�'ner's / /- " --.--------.---.-..-/�-�,.= Phone------.-'----. <br /> Add ~ 1 .__.__-_---.___-_- <br /> Contractor's Nunoa--,-,,�.x��Lx�~�°���_-_...-���s�c��--.---------.--.-.-------.. P�one.�����.�.�z..����d.�r � <br /> |m��� �U ��: R���� � A�dmo� H�� � CommercialE] Trailer C�� � Motel El Other El . <br /> Number ofliving units. /- Number of6odnoomaNumber cfbaths . L Lot size --/ � Jr --------------------------- <br /> Water <br /> __.-_-_.Woter Supply: Public system 0 Community system [] Peivate [-I Depth to 'Water Table 4.��ft <br /> Character of soil to Gravel a depth of foof, Sand ve| 3nn6v Loam E] Clay Loam (]ay A6o6obn Ho,6oun [] <br /> Previous Application Made: Yes [] No �� New Construction: Yo, No [� ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sopflc'fmnk or cesspool permitted R public sewer is available within 200 feet.) ' <br /> Septic Tank: Distance from nearest *eU..A6�6---Distance from foundation----- -Mutarial-- � eo <br /> No. ofcompartments..........~2----.Size-��7�-)C���-.-.Liquid <br /> 6ei'pfh-- ..'-�--C-upnci-t <br /> Capacity-----le--a__-.Disposal Field: Distance �p U /YOAK ��~�� �� � ' <br /> -Numb� of | / <br /> Type of filter material f filter nclength----------- �. <br /> Soeoao* Ht: Distance to nearest well--- from �� / nearest lot line---- <br /> Number <br /> ina- <br /> �O Num6ar of pHs- ---/-----Lining mo+o,io|��.��/��=��B�o� Dia motor--����----Depth--. �2�.z�-.-.-' <br /> . � <br /> --------------- <br /> Cesspool: Distance fn�� n��na� well Distance from foundation .__Lining m*f��o| <br /> .. _---- -_---- -------------------------------------- <br /> 0 <br /> ----_-.--.-[] Size. Diameter _'''-''_-.--'-'-Deuf '-''''�''-_-'�_--'''-.Uouid Cmpuc�y'-'_------'oa� <br /> ` , <br /> Privy: Distance from nooresf we|L'���--- ------------------- -------- Distano, from nearest building------------------------------------------ <br /> El Distance to noope,+ lot line ------------_-..__..__._._-__-_----__-._______.- <br /> Romo6eJing and/or repairing (describe):---- ------------------------------------ <br /> '--'--''--'-'---'--------'''--''--''-----'''-------'''---'''------'-'--'-----''-----'-----'''- <br /> -------------------------------------- ----------------------------­ -� <br /> -'--------'--'--'--------'-- ;-'---'----'---- <br /> -'--'----'-----'--''-'''-_.''-_--_--___.--_-_--__-__-_--___--_-.-'_-'_.--.^__--- <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 la!ws�,)pnd rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing 5iZe of lot, location 'of system in relation to wells, buildings, etc., can be pl�ced 'on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> \~ / <br /> '- - '�- '_-~APPLICATION ^��cr'�u m/ ----------------------------------- <br /> ��nru�onu and/or recommendations: .. --- . _ . _-_- - - ^~��-4K- <br /> --------------------- <br /> ------------------------- <br /> ----'-- <br /> _'-'--'-'_---.'''-'''-'''-''-'''-' -'-----__-'-_''__.__.'--- <br /> ������������������������������������������������������------_-------'---------'��������---_--- <br /> ---'-''-'-'_-_-'---'_--'''-''--_''''--''-''''_-''-'''-_.-''--'''--_''--''-'--.'''-'--'---'--__ <br /> -''--''-'-''----'--'---''--''-''----'''-'''-'''''-----''''--'--------'''--''''-'''--'----''-' <br /> RN/\L INSPECTION BY:-. --- ------------------ Dut:-- -------------------------- --------------------------------- <br /> SANJOAQ0NLOCAL HEALTH DISTRICT <br /> ' <br /> /nn o""m American Street 30D West Oak Street mc Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tw=r California > <br /> . � <br /> ES-9-2M n".is°a vv-2M � <br />