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^ � . APPLICATION FOR SANITATION PERMIT Permit No. �\ k�mmo��o in �� - ` `-Duplicate)` � Du+o |,��6 - �p�kcuf�n b San ea i ' application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC��ON__ ---g --- 11;� -do-iL_LT - -------- ------------ -------------- Iq ----------- --------------------- Nwj Trailer Court El Motel Other 0 Installation will serve: Residence R Apartment House E] mmerci�l Water Supply: Public system El Community system Private E] Depth to Wafer Table ft. Hardpan Character of soil to a depth of 3 feet: Sand E] Gravel E] �ancly Loam E]- Clay Loam D Clay E] Adobe 25_�a, Previous Application �4ade: Yes [] No Construction: Yes E -;No El FHA/VA-. Yes j�-�o El TYPE OF | AND SPEC |RCAT�NS: ` (No septic tank ' permitted Septic n: u�runoy from nuony^` we Distance irom founclafo Jz x.c'��---'' ----------- ------------ Disposal N 6: Distance fwell-110' f-- ---- Distancerom foundation--,/ Distance to nearest lot line ---- -- IV Type oT material--- uaapag- K Distance to near e en=_~��..jo -'u=tonc unqor/*n��._�.-- nearest lot ono-.n��_-'- r!°� +---'� Number of p�.. �ning material �� - .-S�Diameter-. -,7-,, ��umo+oDapi�-°2j�.------------------ Cesspool: ----.Ceopoo: Distance from neun,siweil. -'-'--- Distance from foundation �-''--------- Lining material '--'-''-'---'- El Size. Di°mnfei.--.--_-r'!-------- Depth ----------------------------------- -..--_.Liquid Capacity ---------------------- ---- gals, Privy` Dis't nca from nearest well -.- r-- -------------- ----- from n"vn,s* bu�cl;ng ------------------------------------------ El Distance to nearest lot line ---------------------------------------------------------------------- --''-___'''--____'__________---. _ ~~ Romo6eling and' r repairing (describe): ---------.--__-.-_.__.-^------__---__--._..__._._---__--' ,-_-'---___.___'_---_.'--'---''-__---_.''----.'''---_-----'---_-_'-_'-'-_.--'''-__.'--.-'-----''-' '---'----'-''-------'----''------------------'--'----------------'---'-'-----------' ' ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that Ae work will be done in accordance with San Joaquin County ordinan"s,,��Ia I and rules and yegulations ofAe San Joaquin Local Vaalli District. (Signed) --- 4__ _1*4 ------ -------------- Contractor) 0 '97� r t ------ - (Plot plain, showing size of lot, location of system in t w is, i to wells, louildin s tc., can be placed on reverse -side). 4.CrR DEPARTMENT USE 6INLY APPLICATION ACCEPTED BY ----- 7Tv9_0q-_,,__ -------------- ------------------------------------------------------- DATE ------- -57 ------------------------- 8U|L0|NG PERMIT ISSUED .... ___---------------------------------------------------------------------------------------- DATE '''-'__-'-''-'-----'------ AKo,utionoand/or recommend ations: --------------------------------------- ---'_--_--.___-.---___.-'_---__�-------------- ------------------------- .__.. -_-- - -_� ------------ -'��''-'''_'' -' ''_-' -'''-`--''_-'-'-_-.__._--_ ---------��-_-.��JL.�---.�«��.I>,T�� _-.-- ------ ----------------------------------------------------------------- --------------------------------------------------- - ------'-----'------'--'--'--'------' -------- ------------------------------ �'--��'�''�'''��'�'��'��'��'�'�'''�� ------ FINAL |NSP .<�..., D��--~��..�.��'��. ._-----._.----.. - ` /^. SANJOAQUINLOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak Street /sz Sycamore Strew Stockton, California Lodi, California Manteca, California ~ 814 North ^o^Str"t Tracy, California ~~ '