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� <br /> \` APPLICATION FOR SANITATION PERMIT Permit No. <br /> No <br /> (Complete in OumUcmfe' <br /> Date Issued <br /> v / <br /> plication is hereby made to e Sun Health Di��cf �nu ponn� tpcon��cfand ins�Uthe°o, km/nn 6oa�|6o6� <br /> m <br /> / yupp|icut/on omade incompliance with County Ordinance No 649. <br /> JOB ADDRESS AND LOCATION <br /> -'--'~''~~`�~~'�,--_-=-.»r..~.'^..- <br /> Oxner's Name------------- mr:--..` 7-..-.-_------'---- -------------- ------------------------------ Phone------------------------------------ <br /> Address <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel El Other E] <br /> Number of livin units: Number of bedrooms Number of bafks --/-- Lot size <br /> Water Supply: Public system CommunIty system E] Private [-]` Depth to Water Table--e/oft. <br /> Character of soil to a dep iffeet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay [:] Adobe Hardpan <br /> Previous Application Made: Yes E] .NoJ2"' New Construction: Yes El No !-�r <br /> e~�_ - ~' .. -- / . <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: | <br /> (No septic tank orcesopno| permitted if public sewer l* available within 200 feet.) <br /> tic aj*k: Distance from nearest we|L-----Di,tonco from foundation--------------------Material _--------.--'---- � <br /> No. ofcompartments------����-.G�r_--_.-.-�-.---Liquid 6v�t ---��-----Cupocity---.-���--- ! <br /> _ . %1J <br /> � <br /> Distance from nearest well------------------ from foundation--------------------Distance to nearest lot line-----_- <br /> Num6er of lines----------- Length of each line------------------------------Width uffrenc6--.--.-----_ <br /> Type of filter mafe-rial-------------------------Depth oJfilter material-'�-�'`�-Total length------------------------------------------ <br /> / <br /> Distance to nearest U from Z to \ <br /> fx- ------ <br /> Number �f pits-�~�.--._ ning muf� u| Size:' D�ometec..-�?..~.._-Depth-' -------------- <br /> Cesspool: <br /> -'''-Co,qzoo|: well <br /> �' ^ <br /> i <br /> Distance from neune� U-- <br /> we _-..��f Distance from fnun6ofion---.---L�ning mnf:rivL---_-----�- �\ <br /> F-1 Size: Diameter efer '--------------------------- <br /> Doof6 Liquid Capacitygals. <br /> or repairing (descr;be)%- e <br /> Remodeling and/ -:; <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify fhat I have prepared this application and that the work will be done in a...;-�- n--J-oa-quin---C-o-u-nf-y- <br /> ordinances, State law es and <br /> uln of the, San Jctquin Local Health District. <br /> p/gnad�.-.----- �~��^� - �. ��.� --��-.. �Q*,ner and/or Contractor) <br /> By:-------------------------------------- ' �—(|��� <br /> . � �fn � o— omg� ��. �m � p��� on �v ne � o� � , ------------- <br /> (Plot ------------- <br /> (Plot plan, size of lot, �� <br /> FOR DEPARTMENT USE ONLY <br /> ----IN- PERMIT —ISSUED-------------------------------------------------------------------------------------------- --------- ~``'�'-----''--''---'--�-----'- !� <br /> Alterm+ons and/or recommendations:-------------------------------------- ------------------------�------------------------- ---------------------------- -__.._°_._.____ <br /> '---------_-'_--_----��-��--�°nn�Y�.�.»��---�*��._ �����P�=x�-�- s~H��--��.�.����=...__.__' / <br /> % <br /> --------------------------------------------~~_~-�'-_-__' _---.~__..~~_`.-__-~_�- ----------------------------------- ---------------------------------------------- <br /> --------------------------------------------------------------- --'''_'''-''''---''''--------------------------------------------------- <br /> ------------------------------------- -'--''''_''--'-�-'--''-''--'''--''---'--'' <br /> -U \ � <br /> HNAL |NSP -�__L ^ Do+=_____��71-C-�� <br /> SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street ouSycamore Street uwNorfh "C" Street <br /> Stockton, California Lodi, California wanteca, California n~"v, California <br /> es--9-2 M ' m°.;s°* 1.57 pnox ` <br /> . '� �~ <br />