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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> ' Oafe IssuedT�plica�ion is hereby made to . <br /> o San Joaquin Local Health D-isf,ict for o permit ioconstruct and /insfalffhework herein described.is application is made in compliance v ith C <br /> Address ,q ounf_y_Prdinance,No._54.9_. <br /> -- ---~- ^^ <br /> Contractor's Name' <br /> " --'- -� ----~w��,�n~�-..��=�:�.^m��~~��*�----------------------------------------- <br /> ---------- Phone <br /> -----.-_----.- <br /> Installation will serve: Residence �/\purfment House E] Cpmmon:io| F] Trailer Court [] Wofm| [] Other [] <br /> Number of living units: '1-.. Number of bedrooms Number of baths J-- Lot size --------A.I�7-.��-��.��___.-.__-__ <br /> Wafwr Supply: Public system 60 Community system El Private [] Depth to VVotor Tu6|o j_0'ff. <br /> . <br /> Character of mxU to a depth of feet: 5onJ [] Gravel E] Sandy Loom E] Clay Loam [] Clay [l A6n6mC�~Hun6 <br /> -_ _ pmnLJ <br /> Previous Application Made: Ye, E] No 0�__New Construction: Ya, 4 No F-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic funk mrcesspool permitted if public sewer 1savailable within 200 feet.) --� <br /> Septic Tunk4 Distance from nea,us+ w*U_ isfance from f 6 +ion..ZA.'---Mo+vriuL&. ^ ' <br /> ^ --' <br /> '-~ » - . <br /> - . - <br /> _Q0 No. of comportments-__~� ----- � Liquid ��pfk-6.0--'--Cupu�ty.. ------------- <br /> Disposal <br /> --._- <br /> '. <br /> _ <br /> Dispo, | Field: D|�ance <br /> ----- <br /> Number -� <br /> from nearest building <br /> _' Di�uncef« nearest lot |in*___________--________' ` ___ _- <br /> Type of fi4er material--i-ff----I---Z-Depth of filter material----- -----Total length--------_5'-6. <br /> Seepage Pit: Distance to nearest we�L_/ Distance foundation--- .. .....Distance to nearest lot <br /> Cesspool: Distance frorn nearest well-----------------Distance from foundation--- ----- ----------Lining material <br /> Rem»6��9 o»6/»r repm��n9 /6�c6b�:__________�____________________.____--'-------'--'-- <br /> ordinances, Sta s, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, siowi�n�glsixe of lot. location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> —__-_-------_---_---.---.----_--FOR DEPARTMENT USE ONLY <br /> ------------.-_-----_-------'----_--_-----------�- <br /> '----------------'-----'---------------'—'--'---------'-----'---'--------- <br /> ' <br /> '-'-''-''-''''''—'-''''-----''---'--''--''--'------'-'''--'-'--'''---�-----''--'----''''-'' <br /> 6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> here1Z ---_--_-__-_-- '- - -_' _AKe,mt�noomJ`or recommendations:--,, <br /> —'-' ' ' '' ,__ <br /> - � ^ ^ -'-''--'__''''--' <br /> -- - - -----'----^' - ~� ^~��- -'--'---------------'----------'-------' <br /> . _ ----------------- -- ^-.-------------_----------._-_-----_'_----- <br /> --'-_'--''-----'---' '''---'_'''-'''''-_—''_''''--''�'''--'----'''-'-''_--'- <br /> F|NAL INSPECTION BY------ ----------- ------------- Du*z-'-- 7 .-�' -.—_--_—_- <br /> SANJOAQU|NLOCAlH£ALTHD|STR|CT <br /> /30 south American Street 300 West Oak Sf."f mx Sycamore Street 814 North "C" Streof <br /> StocktonCalifornia �d/. Californiaw°m�=,. California , n="r. California- <br /> .~-~_^~ ~~~.~.~C.;_ , � <br />