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APPLICATION FOR SANITATION PERMIT PennitNu <br /> (Complete— �— Duplicate)' Du+m Issued --- <br /> Applicer�ion is hereby <br /> m6m to the Son Joaquin Local Health District for o permit toconstruct and install the work herein described. <br /> This application is madecompliance with County Ordinance No. 549. <br /> S- ADDRESS ' - - - '------------'' <br /> ��nw,, nmm= -*�u��e�. Phone------------------------------------ <br /> __-ss------------------------- ------------------- '.-- -'_---------_-._-_---__-----_--__- <br /> Contracto/, Nome.-._-'_-_-- ----------------------------------------- -------------------------------------------- Phone_-.__—__- <br /> |nstallationwill serve: Residence Z Apartment House El Commercial 0 Trailer Court 11 Motel El Other El <br /> Number of living ing units; �� <br /> 6 r of6e6ropm, .. Number of 6oH`, .-/-- Lot size <br /> Wafer -----.--__ <br /> �f�, Supply: Public systemQNr Commusystemy system [] Private F-1 <br /> Depth to Water -- <br /> Ta6|� . ft.[havacter of soil to m depth of 3 feet: 3on6 [] Gravel 0 Sandy Lo Clay Loam [] Clay [] Adobe 0T~ HupJpon [] <br /> Previous Application Made: Y=s [] No DR'-"New Construction: Yes URNo0 . <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i[Nn septic tank or cesspool permitted if public sewer is availablewithin feet.), <br /> Septic Tank: Diofonua from noun::+ .�|L������.Dii 161 Mat rial_x�%_ <br /> - - <br /> 50 <br /> No. of compartments---�Z-------------size�-.---- �� �l .5_ icl dop+ ' <br /> Disposal Field: Distance from nearest welL4-----'Distance from found <br /> 21 Number of | Length of each | of <br /> Type cff�er material --Depthof filter mm1e,�L-.I6�����-�Tot | �no+ ''-_-- -------------- <br /> Seepage <br /> Pit Distance to navn,stveU-----.-Distance from foundation--- -----------Distance to nearest lot line_-_-- <br /> [] Number of pits--''''---Lining material----------------------- Diameter.----------------------Daofk�-'-''-''_-''- <br /> Coopon|: Distance from nearest well ._----- -Distuncefrom foun6ut�on------------------Lining material ---.—.-_--_- <br /> [-1 Size: Diameter_----------.Dept k----------------------------------------------------Liquid Capacity......... ----------------gals. <br /> - <br /> Privy: Distance from nevn,,+ °eK'--'-'''-''---'''--Didanoa from nearest building.'--�-''-'''----'- \� <br /> E] Distance to nearest lot line--------- ------------------------------------------------------------- ------------------------------------- -'_----._-- \u <br /> Romo6eing o"6/o, repairing (describe):------------------------------------'--_-__.-'_-.-_-''--'-_.'__----'_-.'_-_-'---'-' <br /> -'----'''—'---'-----'-'--'--''--'-------------''---------'—'—'---'-----'—'--'--' V <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> ..... .. ............. --------------------------------------------------------------(Owner and/or Contractor) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEF�ARTI�ENT USE ON <br /> BUILDING PERMIT ISSUED--------------------): ---- ------ ------ ------ ------- ATIE----(It----------- ------- ------------------------ <br /> __C _:__;�71-__--Ck.*-,:-:--.:-::::::------.---. <br /> ------ks <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> /mm South Am°ricm" Strew 000 west «»°k Street oz sv"°m",° Street ww North ^C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> "=_~_2M `=^^"^,°""" .""^ <br />