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Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> e c (Complete in ~+ Do+e Issued <br /> _- . ^ <br /> App mo6°�f" theSanJoaquin Local Hua|+6 District for o permit +nconstruct and 'install the work herein 6e,c,6o6. <br /> This application is made in compliance h fy Ordgjnance No. 51�� <br /> ���m xuux�uu xmu LOCATION ^ —_�p.c..^,'�,w-�^°�`'^~�"~~�=�',—'''~~' �x <br /> Owner's Nnmu-----�' l��x���.----' -- --------- <br /> ----------------- Phona� -- <br /> Address------------------- .......- -------------------------------------------------- ---------------------------------------------------------------------------------------- <br /> - - <br />: <br /> Contractor's N -----.---------------.--- Phono. -_ <br /> � - <br /> Installation will serve: Resi ence Apartment �Ho� [-] Commercial' 0 Trailer CourtE] Motel 0 Other El <br /> - Numb | <br /> of ''` unH /.�— <br /> t� ��Number ofbedrooms Ir"'Num6u, of 'baths I Lot sizek9 x- ^—_--._-- <br /> Water Supply: Public system � Community system F1 Private E] Depth to Wafer ft. <br /> Character of <br />� ' � �-u �� � 3 f�� �d 0 �� � ��y �m 0 C� �m � Clay � Adobe PC <br /> Hardpan <br /> i �] � No Ne* Cuny�ucf�o� Yes No ~i <br /> -~ ' < <br /> TYPE CJPINSTALLATION AND'SPECIFICATIONS- <br /> (Nb 000fic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance f.rnm nearest well-----------------Distance <br /> ' from foundation--------------------MutnriaL--_-------_---- <br /> 171 No. ufcompartments--------------------------size---------------------------------Liquid depth-------------------------- ----------------------- . <br /> ^ <br /> Disposal Field: Distance ^rorn nearest.we4_1YVA(P___.Distance from foundafion--/49-----------Distance to nearest lot L' . <br /> --------------------- <br /> Type of filter maferial],YA---Pf Depth of filter rria*'al----/Y-----------Tofa'l length---- <br /> Seepa e Pit: Distance to nearest well__XA(V�C----Distance from foundafion,_/O..........Distance to nearest lot ----------- <br /> Number of p��-�-_—._Uning material 3��� Diumo+�c�����---�Deof�����—___.._-� <br /> . ' <br /> -Ces p"o Distance from nearest well-----------------Distance from foundation-------------------- material —____'----__- � <br /> 5be: Diameter_-'^_—.—''''—�__Dep|�—_-'''--'-'--__'—_''--_Uq�d Copoc�y-----_—'—_-qu|� <br /> ' <br /> Privy: Distance from nearest well------------------------------------------------- from neorosf building'—'''__----__.---_ <br /> [idancetoneu,est |n+ line------------------------------------------------- ---.—^^.___.-_--_'--__—_—_--__--^----. <br /> '`~^~~~''x and/or° '~r~^^'g (clr`~~'~° ----'' <br /> _—_-----.._____.--...�_______~-~—~.__.__—.__—_____-�r_____- .__- ~.___-___---__._.—_. <br /> --_---__--____=�-___—._.._—_______.--__.-_'-___.__--____—_ --___---__._______--_._' <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ____--__—_.—''-_ ' <br /> I hereby cerfif tha ha.ve prepared this application and fhaf the work will be done in accordance with San Joaquin County <br /> re <br /> c 'p g <br /> ordinances, State aw , an rules and regulay'ibris of the San Joaquin Local Health District. <br /> (Signed)�----------------- ----- - -- ----li:_ ------- ------- <br /> i t f. 2i -be p- <br /> tion of system in relafion to ells, buildings, etc., can <br /> (Plot plan, showing of, Ioa n fe lace on eve e sid <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------------------------- ------ DATG'''------�. -------------- <br /> ---------- <br /> ' <br /> REVIEWED BY..__--_—��_—'_-- .--�---��_-- --------------- DATE---�--1.!_!!.--�..�_.—__._. <br />_ DV|LD|N(� PERMIT ISSUED_''''—''—� \/_--'_—''—''''-'''—'''—_'''''—'�. DATE---------------------------------------------------------------- <br /> Alterationsan6/*rrncnmmon6u+ionu----_------------_—._--._'-_^—..__._____.___________ <br />. . �---''—'--'-'--^'—'''_--��'''—_'���--.'—'''''—''------'--''''����-''—'—'''—''''--__—''--'---'_—'- . <br /> � <br /> ----------------------------------------------------------------------- ------------------------------- --------------------------------------------------------------- --------------------------------------------------- <br /> ------__------_------_������_-------_-------____-------___-----__---_---____��_�_-- ------__---_______-----___------____------'___�����_���_-----_-----__- <br /> ^ <br /> .-''---'—'--''—'''''—''''-� --------------—�''—'—''—''''—'' --_'''—''�--����''—''''—_'''--_—'''--''_—'--''- <br />' �w �n <br /> FINAL INSPECTION 8Y��~��� -----. .. Date---- <br />' SAN JOAQ0N LOCAL HEALTH DISTRICT . <br /> /30 s"mh American s+=.* yoo vv°* Oak emm /»z Sycamore strao* o/* w"rth.~r' Street � <br /> ^ <br /> Stockton, California Lodi, California Manteca, California na"' California <br /> - <br /> ES-9-2M 8-51 Revised W-2100 <br /> ^ ` � <br />