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� ~ APPLICATION FOR SANITATION PERMIT ~ 9ermh Nu. ------------------------ � Omo�a�) (Complete- - Duplicate) |oumJ��.��.'��' Application ishereby ma6e.tothe Son Joaquin Local Health District for apermit +oconstruct and install the work herein described. This application is mu6o in comp|i�nce �lth (��unty {�,6inunc� No. 549. , . ' --- ADDRESS ' '- -~-~-t`'—�~a�-`r'=�----''---___---__,____ __----_----_---__.. Phone----- a��=~ - _�r�-��-.��u'�v�---��4��--------------'---'-------�--------------''� ' Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone------------------------------------ Installation .._-----_----_-_|nstallation ,ill serve; Residence Ej /�admo� House F1 Commercial � Trailer Court [] Mc�| � Other ]� � / -_ - . �� ^ Number of living units. __4--- Number of 6odn,vms --° Number of baths _~�� ' Lot size --.--_'- VVatn, Supply: Public system ' Community system -F] Private Depth to Wafer Table --- ft - � Character of soil tomdepth of3feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe 5� Hardpan ^ | Previous Apr'— ' Ka6o: Yes E^] No IM Now Construction,' Yes K No 0 ~° TYPE OF INSTALLATION AND SPECIFICATIONS: ~- (No septic tank �r �oo�pm�| pn,mn�MeJ R public sm*a, is available within 200 fno+J ` ^ � �~ »^�. ^� �� Septic Tank: Distance from nearest we| ~x-..Disfo f � on--*^�-'-r��^+nrinL--��y��*�,,.-.. Disposal Field: Distance from nearest we��---rO-----Distance from foundation-A-4..........Distance to nearest lot line---,r-------- - Seepage Pit: Distance to nearest well---110-----------Distance from f4LVafion---7� Distance to nearest lot line-----,C---------- ' ------------- Cesspool/ Distance from nearest well-----------------Distance from foundation--------------------Lining material --.--__------- E] S�zo: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nounyut well _--'--�'��'''�-'��Distance from nearest buikG ''-''-_-'___--'--- �] Dis+unce fo nuonaxt lot line----------------------------------------------------------------------------- _-mg °n6/u, repairing '-''''__.__.-______� Remp6e __-_.___.____---___._.___--..__._._--___--_---_-.__'__.---_--_---_-_.____-._----_ --__.__--__--_--_--___.-_-.__._---__---_-.___.._______---__---__.-_.__.___----_-- -�_'-_�-'�_---.'-''-'-'--'---'''-_-.----_.--__--__.�''-__�-_�--�_.��-''-_^''____'-----.---_---. | he, thataccordance w�hSan Joaq�n County rices St, UGnn - -.��'--_--._-'--. and/or Con�ucfo, ^ � ---''-_.'--_'''-__'''--''''-(Title)----------------------- ~ (Plot olan, showing size of lot, location of system in relation to °eUs, buUJingo, otc, can be placed on reverse side). FOR DEPARTMENT USE ONLY ' � APPLICATION ACCEPTED BY i ' � '' x� � �� ' - -- ----' DATE � [_/Z/ '^--- ------------ REVIEWED QY_--.----_-------' �� ..�-..�.�--------------_----- DATE PERMIT ISSUED-, _-.------- ' DATE .----'�-1i^--i�----«� ~o^��--�11_ ---------------- --------------------------------------------------------------------------------------------------------- Alterations and/or recogwINenclaf ions:-- ------ --------------------------------------- ----.. '_-'--''-_-.'_-''_-'-'--.'''''-''''''--'''-'''--_'''-_-''-__''----_'''''--_-'''--.--- -___-_--_ ______-____________�_________�___________________________________'__________'_________________'__ ._-___.----._---'-_--._------.__-_-_-_-------------_-----__._-.__-__-_- FIN \L' INSPECTION BY:- �� Do .' - - __--.-�- -�---L_'-.L^^---�1'---^-�-��__~-�-�_ -_ SANJOAQU|NLOCALHEALTH _- ��R�7 130 South American Street 300 West Oak Street /32 Sycamore Street 814 North "C" Street � Stockton, California Lodi, California Manteca, California Tracy, California � ES-9-2M Bu| n^.uo6 vv-2/00