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+� FOR OFFICE USE: � /-�` � APPLICATION FOR SANITATION PERMIT Permit No. � (Complete in Date |omue6 --------------------- This Permit Expires 1 Year From Date Issued � Application is hereby made to the Son Joaquin Local Health District for a permit to c8nstruct and install the work herein described. This application is made 'in compliance with County Ordinance No. 549. JOB 'ADDRESS AN � � ` NumberInstallation will serve: Residence B-__A�parfment House C] Commercial 0 Trailer Court [] Motel F] Other [3 - ~ Wafer Supply: Public system F_ICommunity system [] Private E] Depth to Water Table o5V ft "v | � h�� Sand [� Gravel � San Loam ��y L�� O /�� m��n � Character wfo*Y fma �R� � a" ,nvo �� -, ~~ Previous Application Made: (If yes,6ouv.1157.1�-------- No F! New Construction. Yes No e�HA/VA. Yes E] No El .� TYPE OF INSTALLATION AND SPECIFICATIONS: septic*(No tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well . Distance from foundation -Mo+aria| . Nu \`. ofcump��man�.--'_-._-..�;za-__'---_._--Uqu�6 6�F��-_------�opuc��---_--_- ' Distance from neona� ~�i'-'-'_��tmnca from fuumJut�n'_----'--D|�unce to nau,e� ht Uno_----_. �u I.Field' � Number of lines-----------------------------------Length of o�c6 line - �Yi6th of trench- . Type of filter motnrioL. Depth of filter muturi*L---_--Tot | length_._.__`_ Y�\ e m D�stance to nearest well MW---Distant, m6 �m / nearest lot Numn6erofp�o-' �'-''''Un�nq material__P e, uoumoterx�/9---_-Depth--.^�^e�._--.- ~ ' Ca0000 � Di l: nearest °=|L_.--'-Di��noe from fuundu�pn-''''---��ng mote,�i_''-'--'--'''- °u ' ' � Size: Diameter--------------------------------------Depth-''''''---__-'''-__''--Liquid Capacity-'_--_---gam. ^� Privy:' Distance from nearest well--.�---_--�_----Di�unco from noum` building------------------------------------------ }( - Distance to nearo� �tUno`---__-'_-----'_.__.--__.---_.._--.--.__..--'''_'-------------------- � Remodeling and/or repairing (describe);-''_-''--''---_--''---_--__---'___'-----_--_--_-.'-__''----_-----'- --------------------------------------------------------------------------------------------------------------------- '--------- ----------------------------------------------'------------------------------------------------------------------------- --------------------------------------------- ---- - ��'_��__��__��'��'��'��_��'___��__��'_��'��'��__��_�___� '------'----'I.hereb e 'fy that I have prepared this application and that the work will bedone in accordance wifhSunJoaquin County ordinances,/Sf ateilaws, anA rules and regulations of the San Joaquin Local Health District. (Plot plan. showing size of lot, locei-i-o--n----oi,_s_y__4e__m_ 'Tin relation to wells, buil n9s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --------------------------- Alterationsand/or ------------------------------------------------ _._-_----'-------------------------------------_-'---'''-''------ ` ^ --_''--'''---'---''_------'''-''-_-_.-__-- - �� _----'''--'-__--'_--_-'__'.___-- .----''�---'�-/--''-�'�=^'--^-^'--'�^v--~-'~--''------''' --------------------- --------------- __-------------------------------------------------------------------------------------------------------- ---------------------------------------------------------___ '-'-'-'--'-''--'----�''-'''-''---''''-'''_-'-'----'-'''-''-''--'''�_-''_-''--_''-'--_-'--'-- FINAL INSPECTION BY:-.... Date--^�� x-'''-''-'--'--''- SANJOAQU|N LOCAL HEALTH DISTRICT 130 South American Street ovpWest Oak Street 12*Sycamore Street 2nsWest 9th Street Stockton,California Lad],California Manteca,California Tracy,California =."°°''""p".=,^=".,~^.°"