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� � <br /> APPLICATION FOR SASANITATION�T� P���[7 Purm� Nu ~� -�.7� <br /> k�ump|wf� �� �up|�nm�A /~ <br /> ` ' D�fo |soue� �����l-.----. <br /> 44 <br /> aifio'n is hereby made to tfic�'San Jcf6q in Local Health Dis+rict for a permit to construct n e work herein described. <br /> This application is made in compliance with County Ordinan5k No. 549. <br /> JOB ADDRESS AND LOCATION <br /> `'"''"' " '`~'= -�����.�-------------. Phone-----------.--.. . <br /> /\66,eo-_-- ������x��~�� ���.---- -------- --------------------------- <br /> r <br /> --_--_-___ <br /> Cuntrucfo/s Name'-__'____-_.--___.----'-_-.--J�--_----�_�-�-------------------------- Phone-------- ------------_----------- <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel Ej Other <br /> Number ofliving units- f-- Number ofbedrooms '�/Nvm6erofbaths J <br /> Water Supply: Pvbiir :y,+om El Community system ��� Privn+e �m� Depth to V��� � <br /> r� f|_ ~~_.'^ <br /> Character of soil to a depth of 3 font; 5on6 Ej Gravel E] Sandy Loom [] Clay Loam [] Clay W��� <br /> Adobe[] Hardpan [] <br /> ~�/ Construction:Previous Application Made: Yes 0 N �W New C�n�� c+ion� Ye, P�'� . <br /> No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: -- <br /> /No septic tank or uompow| permitted if public sewer is a°mUwb|e within 200 feet.) <br /> Septic Tank: Distance from Distance from foundation----L�� �n <br /> No. ofxompartmont,--�k--------------Size----- depth *�-. 0��� .. Cx <br /> Disposal Field: Distance from nearest °eU.J&0-Distance from {u dz- �. |� <br /> -17 <br /> I� Number of | __I. ]a' ` Type offi/+e, mate of filter ma+a,ioL-../-W.1To+o| length 115,6 <br /> 3uapage Pit Distance to nearest well---------------------Disfonce from foundation--------------------Distance to nearest lot |i <br /> [1 Number of pits----------------------Lining material----------------------- Diameter-----------------------Depth--_____ <br /> |: Distance from nearest well from foundation--------------------Lining material -'''--'-_''----_ <br /> [] Size: Diameter_---__._--_- Dept 11--------------------------__--_--Li�uid (�op�c�/.__----_.gu|c <br /> - ' -_ <br /> Privy: Distance from nearest well��''-__.'--�'''--''-_'Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line---------_-.__--._'_-__.__--_-__--__--------'--- <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 /> (Plot plan, 'showing siz�3 of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> BUILDING PERMIT ISSUED <br /> Alterations and/or recommendations:- __c <br /> ._�'_-�-'---''--.--''-' -------- ��_-'' _-'''''''_-.--''--'__.'-_-.-_-. <br /> RN/\L INSPECTION 8Y:--- ---- - Date----------- I—�..���-_-__--. <br /> SAN J[�AQ0N LOCAL HEALTH DISTRICT <br /> /30 s""m American s+r°w ouoWest Oak Street /xz Sycamore sfr°°+ u/* w"+h "C" Street <br /> Stockton, California Lodi. California Manteca, California Tracy. California <br /> ES-9-2M o's/ Pe~i"v6 vv'x/om <br />