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_ <br /> � . <br /> Permit No. ...... <br /> APPLICATION FOR SANITATION PERMIT <br />�- <br /> S. (Complete in Duplicate) ��tn |�,006 ..�//[�1s'�' <br /> ~ <br /> ApoUcofm" is hereby made tothe San J ' iLocal Health Dis-iricffor a permit tn construct and install the work <br /> herein describThis application is made in compliance wifb County Ordinance ed <br /> No. 549 <br /> --------------------------------- <br /> e [] Commercial E] Trailer Court C] Mot9l [J. Other [3 <br /> Installation will serve: Residence [?-"'Apartment Hous 4)��' I <br /> Number of living units: umber of bedrooms __&_ Number of Lot size <br /> Water Supply: Public system ;/Zmmunify system. [_1 Private [] Depth to Water Table -------- ft. <br /> Loam E] <br />� � '-^ � .. ' <br /> Character of soil to w depth of feet: S*"" . <br /> New Cono�uctn ; _No 0 FHA/VA. Yes E] No <br /> Previous Application Made: Yo, 0 No' <br /> m� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank or'cesspooi permitted of Li 1C seyer is av <br /> ce frornjiouoation__/__O��af4e )i---&ZA - -------------- ----- <br /> T64: Distance from nearest well ista �1�-------i- <br /> 14 Distance fro­ml�founclafionj �['jstance to nearest lot )in �_Tf <br /> Number of <br /> | lines^ ' -/ <br /> ' |' -mu+rr.o|' <br /> �I.��-] <br /> Total �mgtx '---''-'f <br /> Typa of filter =^ fou foundation ' s�'_'---_-'- <br /> - - <br /> »eep* Distance to nnon,� w�l--'---�'-O�+ance from [ line <br /> Numborofp�,-------L�ing mafernL''''��-''-,Szo: Diameter--'''-.'--Depth '--'-'---'''- <br /> Cnsqpoo . � Distance , /-rxnearest well Distance from foundation � Lining material _'''-'--'_-_ <br /> ESize: Diameter- � O�pf h-------------- ' _______Uqu)6 Cupnoity--------------------------- r`~ <br /> � <br /> ~p6~y: " ^ Distance from nearest well ------------.�--'C»�anoo from neon�tb�kng''-''-''----'-''_'-' <br /> C`m <br /> Distance to nearest Fne':-'------'�'''''-'-'---'--'''-'-'''-''__________�__________ <br /> .�---_._-.___--�--. ---__.''---'-_.--'---' <br /> °=. o\ --._------. w <br /> -..__ ---__---__'---''-_--'-'___''-'---'--'__-''-----.'--'-'--'''--- <br /> '- ' '--__.'-__.''-_.���--_-- -_____--___.--.�'---__-.___.--_---- <br /> -__-'-'___'''-___--.--.--'''''--.''-'-'--''''' <br /> --------------------------------------------------------- ---'-----'-------''ation 6-H,mtfhe workwill be done in acoo,Jmnoo with San Jmaq�n Coun+y <br /> ) � ' "=~" r~r~'~~ -- -'��'� SmnJ6aquh`-Lo*uiHemKh District. <br /> � <br /> n6 ,u�� d ~^ ' � <br /> ordinances,^ � � ' C <br /> �______ ____-_-__.___-yO*nor amm/"v C"""�°."~/ <br /> ��ne*�.-u-'�--��^---^----''--'---� <br /> -'----'''''''''--'-''-'`-ie),-_'�� <br /> ---'-'---' <br /> ---'---- <br /> � ~r-------------'------''''---' <br /> UP|nt plan, showing size of lot, location of system in relation f-cs wells, buildings, etc., can <br /> be placed on reverse side) <br /> � <br /> FOR DEPARTMENT ._^ -..-. <br /> DAT <br /> � <br /> ' -_-_-_ � -' <br /> _._- ---__.._-.-_----.------------------. _ -------------------------- <br /> --�-_-- <br /> -'- � ` -_--.. --.-`-'--'__'�_---_- <br /> _-�__---.�-�__-._-----_ ----'_-_----�-� <br /> '_-- <br /> --.----_- -- --__-_ <br /> -.'--''---.''''- - z � ----.__--._- <br /> .m ~RN/ L |NSPECTON8Y�'' Du+n- --------------- <br /> SAN <br /> � - <br /> SAN <br /> JC}AQU|N LOCAL HEALTH DISTRICT <br /> 814 North ^o^ S+�° <br /> � 130 South American Street »o» »»"m ��°� s+`" |»z Sycamore »�w° r ,» California ' <br /> Stockton, California Lod,. Californiax�=w=". o°|ao"am = <br />