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APPLICATION FOR SANITATION PERMIT Porml+^Ng, (��mp(w�" �n �uo1�om�n) ' ` Duplicate) Date Issued _.-_/../��e�� ' . AppUca � b hereby made to the Son Joaquin Local Health D�+6� construct tforu prnniftoon6 install� thexn,k herein described.T6� upclicufinniy nmdo incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT|C)N--1-` -.. --------------- _________ O wner's Name---�� \ --.--_.----_--- P�onn-----___-' '~.. ~~-._..~`..~~..'_^�~-_-^.__._.--___--_--._..-_.-___--_-___.__-_''__.--___ Contractor's Nome----tJ/am�° - ---------------------------------------------------------------------- --------------------------------------------- poono-'_._------. serve: Residence f& Apartment House E] Commercial E] Trailer Court [] Motel [l Other El N--be, of living units: -\-. Nu' 6or of bedrooms Number of baths -\- Lot size ------------------------------- Water ____'-_Wator Supply: Public system IR Communify--system -E]- Private [] Depth to VVu+or Table -'- ft Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam F] Clay Loam E] Cloy E] Adobe a Hardpan 0 P,o°|nus Applic'Aiion Made: Yo, [] No N New Consfmc6on: Yes S No E] FHA/VA: Yes [] No %L TYPE OF Of |NSTALLAT|ON AND SPECIFICATIONS: (No septic tank or:cesspool pn,mK+e6 if public sewer is available within 200 feet.) Septic Tank: D�,+onxe from nearest wu|L\&x�»��'Di�nnco from found^fio--�r+.---h4�te�in---L.~ »�. _--- . rg No. cfcvmpurhnont�-..��.----.S�e-��g�.�"��_-� @ � --� q� �n�6 + ._ � Cup� t�.]M)�./��. - /- ' DDisposal �o|d: Distance from nouneof ^mU..]a^u��'D f fo di n _1J0Disfan.ce to nearest lot --------- Nvmber of lines _7�= Length of each |i of��nrh -..�,��.-.-._-. ,+ Tvoo of filter material '''Duo� of filter mofnr�L- [� »�'+ �otu�|�ngH�____ Q1] ' '_---_'' v\ Seepage Pit:Pit: Distance to nuunsfwu�L'- -----Distance from founduHan on_ 6_^---Distonceto nearest lot --' 1�9 Number of pits--------\------------Un�ng mu+ariaL. ------Size: Diameter-4-1—&-18t,-----Depfh---wa^--._---- : Distance from nearest well----------------Distance from foundation-��-'-Lining material '''-'-'---'-''- El Size: Diameter----------------------------- --------Dept h----------------------------------------------------Liquid Cm9ud-ity---- ----------------------gals. Privy Distance from neores� w°U--''��---------------------------------Distance from nearest bui|cli ,-'--'''-''_-''-'- ElDistance to nearest lot line------------------------------------------------------------------------------------ ---------------`._----.------- . � . � Rumodeling and/or repairing (6osc,ibu) --------- �''--'''''_-'------------------- --------- ---------------------------- ------------------------ ........ ---------------- -----------------------------------------------------------------------------------------'----------------------------'-'-----' �_��_��_��___�__��'^__��'��_��_��_��'__��------___-----__---_-----_---_-----_�� ----------------------------- ' I hereby certify that I have red Ais applicationand that the work will be done in accordance with San Joaquin County ordinances, State laws, and rull andd re ulaflons. of Ae San Joaquin Local Health District. \ ' _ �� Z '''--''-'-'''''-''--''''-'-----_-'-jowne, and/or Cwnt�o+nr By:-_________.___________.__-__-_----.__-_---._._yme)----j----------------- _-_._�______.� (Plot plan. showing size of lot, location of system in relation to wells' buildings, atc.. can be placed on reverse side). FOR DEPARTMENT USE ONLY � ^ --------------------------- - IR—�S-AR-JoAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wait Oak Street 132 Sycamore Stre7 814 North "C" Street Stockton, California Lodi. Calffornia Manfeca, Cal;fornia Tracy, California / ES-9-2M Revi5aa 1-57 F.P�CO