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APPLICATION FOR SANITATION PERMIT Permit No. <br /> ..... ------------ <br /> (Complete <br /> ------_ <br /> (Cmnp|efm in Duplicate) <br /> Date |�ouod <br /> ^ Health � mJ?T, <br /> .� <br /> ' <br /> pplica4-ion is hereby <br /> nacle to the San Joaquin Local <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND,L9CAT19N.. 49 A> 0 <br /> ' <br /> Contractor's mome_.'f _.-��.--- --_-----_.-----_---.-.-_.-_.. rnvn=,x,Q' 7- ` <br /> � |nstallation will serve: Residence Apartment House [] Commercial E] Trailer Court [] Motel 0 Other [] <br /> / � �� <br /> Number of living units: /_. Number of bedrooms ___2__ Number of baths ..^^- Lot ,�o '_�»-���-.^^r.���----._---- <br /> Water Supply: Public`rystem [X Community system E] Private F� Depth to Water Table t-�. ft. ^ <br /> Character of soil to a depth of feet: Sand [-] Gravel [:] Sandy Loam El Clay Loam 1:1 Clay El Adobe '� Hardpan El . <br /> Previous Application Made: Yes E] No Cg New Construction: Ye,4 No [:1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No oop|� tunk o, cesspoolponnHmR �o���, u available � <br /> � � pv6ylo6| � o� <br /> within ��� ftJ <br /> SepticTank: Distance �r� nearest woU-/J�#e''Dl,fan foundation-'/�/-'-Material /' +n � -.-- <br /> 'compartmentsNo. of � �2 ......��� �����^ � */��'' <br /> Disposal Field: Distance from nearest well.-A-4de-Distanc�e from founclaflon-J.-f----:-----Distance to nearest lot <br /> Seepage Pit: Distance to Distance to nearest lot line-,---0---- <br /> ^ -------------------- <br /> Remodeling and/or rep�iring Wsuc��ok--^�� -.---- -_.-_---�-----.--------_-----_---'--.-----_-_----- <br /> -------------------------------------------------���----_----'�=r��---_-----.�__------_-------_-------_---_-.--_------- <br /> , ' _- . <br /> .-____-___--_--- .- ---_-..--------------- '' -----------'-- -----_..--�_-._- --.�-_--___-___'_._--- �~ <br /> -'-'--'-'-'----''--'''---''--------'----'''--'--'--------''''''--''-'---------'''-----''-'-'- <br /> ^ ��x-m o| n6-�� accordance <br /> ordinances, Stat�a !s,,' a d rules and regulations of the San Joaquin Local Health District. <br /> .-W <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br />=- uEv|EvvEm BY <br />. BU|L0NG PERMIT ISSUED----------------------------- ---- ----------------------------------- ------ t-.-- DATEAJhormtions and/or recommendations:------------------------- -----.---_---------_---.-------.. -.---_---. <br />` .__--_.__-----_-----__-----.---'~'_--__-____---__-_-----_----.___..___._ <br /> -------------------- __-------------------------------------------- ----------------------------- ----'------------------------------------------------------------------------------------------------------------------- <br /> ''---'--'-'---'-__''''''-----''''_-'''-''�---''''''----_'-----_''-'--''''--_'-_'--�'--------'''--- <br /> » <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------- <br /> � <br /> ` ^ FIN/\L INSPECTION BY:._ --------------------------------------- Date-''' �� �� '��� -------------------------------- <br /> SAN <br /> ''''-''''_-.'SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> ' /nn South *m"ac°" Street 300 West Oak Street /32 yv=°mo= Street 814 worth ^cr' s*w° <br /> � <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> \ <br /> ES-9-2 w m"./""a W-2 100 <br />