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° <br /> ' APPLICATION FOR SANITATION PERMIT <br /> \ /' K�mmp�|e � Duplicate) ?g <br /> ` '--' Date IssuedApplication js <br /> ^ <br /> ane6v made to the San Joaquin Local Heo/H` Dist hcffor it to construc and | U <br /> th ork herein described. <br /> i <br /> Installation will serve. Residence <br /> Apartment House El-Commercial r-1 Traile' Court 0 Motel El Other [j <br /> 1E Lot size ---/-()/ <br /> Number of living units: ---/__ Number of bedro7m-s Number of ba s <br /> Water Supply: Public system E] Communi--- <br /> ty system 'El Private E] Depth to Wafer Table -------- ft. <br /> Character of soil to a �epth of 3 feet: Sand E] Gravel E] Sandy Loam E] lay Loam El Clay El Adobe 6__�Hardpan <br /> Previous Application Made: "Yes E] No E] New Construction; Yes �, I�001 <br /> TYPE OF INSTALLATION AND.SPECIFICATIONS: <br />, This application is made in compliance with County Ordinance No. 54 Tn <br /> JOB ADDRESS AND-LOCATION- <br /> (No septic tank or 1�penmitfe6 if public sewer is available within 200 feet.) �»m <br />^ <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation --------Material <br /> ------ -----_-� <br /> [] No. ofcompartments------------:--------------S�ze--------------------------------Liquid <br /> ordinances, State 11 IS, a2d rules an egplations o the.San Joa uin Local Healt District. <br /> ' <br /> �~e.-_�h�--------------------------- <br /> .__.'-__- <br /> ---'~-_-. <br /> -�-C_-up--a� c_-��~_--�--_--_---^_-_^---_� <br /> .--_-_---_---'-- <br /> _-_---_- <br /> - <br /> [SeepTge P* Distance to-neare well---46�,�----Disfanc;,Tfo m fjou afion/__�_e---------Distance fo nearest lot <br /> qPo, | Field- D � m ".-_�'- �nco6ofun�of�n---..__.-Didonceto nean,� �t |in�'__.� 'F Number of lines_-''__�-'''----Leno+ of each |�o'-----''�'�L--Yidt u{ �bnch <br /> Type of filter material -Deot of filter material Joto| |enof6 <br /> .~. p~.. Distance from neun�rwell--_-_-'u/�n"cofrom foundo+�n---'�__�ning mmfe�nL-_-''-- <br /> � <br /> �~~ <br /> N <br /> ~~ <br /> |. <br /> - -LS�e: Diameter ---'-'-''''--'''Dup+h''''''''''-_.-'^'''-''-_Uoui6 Copuc�y--_.'-_- _- <br /> Privy: Distance from nnon�fveU-----_-._---�------D�h,no: from nearest building <br /> Distance to noora, �+ ||ne' ----'-''-----'-'--'---''—Remod��g om6/o, repairing h6oyc,b��'''' <br /> xi� 1219 <br /> -____.___.________._.______ _ __.___.-__--_-__--_-___--__-.________'___ <br /> -_-_____--_-'__.-____.-_-. ---- __..___-____._---�_.____-.__--.-___-_--_-_ <br /> _____________'______________________'___'__________________will__ ____in_�__acco __ <br /> / quin__ k <br /> _ �~_ <br /> -_By�_. ` 'Kqoto�n. s&enf �t /ocmf�nofoy�omimre�t�n +p *n|�. 6uUJ�g' e+n . can 6e placeFOR DEPARTMENT USE ONLY <br /> APPLICATION <br /> ACCEPTE <br /> � �-_ - '-_'''- <br /> RENEWEDBY------------------------------------- ---------------------------------- DATE <br /> BUILDING PERMIT ISSUED ._----_._--__-_____---__ -'---''--''---- ' <br /> _-. <br /> AHw,mMon» and/or ,eoommen6wHqmu----.--_-'_._-_-_ <br /> --''--_-----'---__.''__-'--_.'''_-''�--'''-''-''''----''''''---_-''---''�-__-'--'�__.-_�. <br /> _'-_---__---_-._---_-.----__-----------_---'-_^._-----____.-._ <br /> _________-_____________________�______________________�____________________________�_____ _ <br /> '-_'-_''--'---'--'--''_--'''-'''' '-'''---,'''''--''--'----__---''---'- . <br /> RN/ L INSPECTION 8Y�' --- D°t�- .°^ -''-'''- ' <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT/so s""* American Street 30D West m°k Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California w°�� ��� Tracy, California <br /> ss--9-2w v'v/ x=/`°a vv-2/00 y <br />