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' <br /> \ ° APPLICATION FOR SANITATION PERMIT Permit No. � <br /> ���� � ��o��a <br /> ` -' Duplicate) <br /> Date |oouo6 <br /> /. <br /> em6v made to the San Local Health District for u permit to cpns�uct and install the work herein described <br /> Th'sapplication |xmade in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---- --- --- . ......- __ ~~~''--_' ------------------------------------------------------------------------------------------ <br /> Owner's <br /> - -_..[)wner's N 12--~--- -------- - ---- ------------ - Phone.����������'���^ <br /> AJ6reo�.__.---_.._-��-- -'--'�..__.-.__'_-__---___--_._---___-._---.-------. <br /> � . ~ / <br />^^ <br /> Contractor's <br />?�} N ----------------------------------- <br /> Installation <br /> - - ' -� -� ' --� <br /> -''-' <br /> |nsta|lation � <br /> will ��� ��em�`p� Apartment CommercialE] TraiTraileCourt - <br /> � , CW E] � El <br /> �O+� ' <br /> - �' � <br /> Number of living units: N -r� �`Num� nf bedrooms ?,-Numbw, of baths ' Lot size 7_---'-'---- <br /> ~. <br /> Woter Supply: Public system M Community system [:1 Private F Depth to Water Table -------- {t <br /> Character wfsoil to a depth wf.3 feet: Sand C] Gravel [] Sandy Loom LJ Clay Loam E] Clay []'^.Ado6aa Hardpan E] <br /> P,e°|nuo Application Wm6o: Yo` E] No F�- New Cons+,wction:^Yeo [� Mo @5 .�pHA/Y\4. Yes DNog] � <br /> -' ~_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank o,cesspoo| po,mHfoJ R public sewer is available within 200 feet.) � <br /> , ° ~� - <br /> k Distance from nearest w�|L-----Distance from foun6ution'--_----��utoriaL--_-------------- <br /> No'of cmnpor�m�n+o �i9*--------------------------------^ �qui� 6eRfh (�opoci+y / <br /> ' -------�- t --------'' '--'--'--'' \ <br /> ~ ' u�V�x 4� � <br /> Disposal �o>6: Distaoco.fnom U Distance from foundation1 D ---- ~~ �k <br /> �Nombo, of | ' Lengthof each line ��� ofhnnch_�� �- �--_- <br /> ~� ` p� of fi|+�, mof��%�. -'D� , of �|h,r mofe,iuL.. �«�r."v �n+o| |ono+ -.����-�__.-_.. <br /> . . . <br /> � <br /> Soepoga P�: Distance to nearest 'Well ''-_''-''Distance from foundation-------------------Distance tvnearest lot line----------------- <br /> Number of.pits----------------------Lining <br /> --'--'-Num6erof,pda---.--._Lining material __-_-.3ize: Diameter--------Depth -----._--- � <br /> Co, poo : ^ Distance from nearest well --'''--Distance from foundation-------------------- material-''---'-----''- <br /> [], 5�zm: Diam�ec-.�-----.-----Deo+ -----------------.�qui6 /�upvc�y---------.gu|� <br /> ''' . . <br /> Privy-. ^^ _ Distance from nen�twuU''���''''_-'--'''-'--D�tunce from neare, building------------------------------------------ <br /> [� ` D�+°ncv +on°on,� lot line.------�------��,_� ------�----------------------------1-!------------------------------------------------- <br /> . Remodeling and/or <br /> . (clescrik�-------Ztf.FAXAA1 6 <br /> ' ~ _-__' <br /> / <br /> -___-__.____-_--.-=�_'_---._-__-.___..__-_-__----_--_-_--.--'---.---_-__-' <br /> ' . <br /> --_'-'--___.'_---'-_-_-'__''�-----_-''-_---__.'__''-_.'___'''--'-_'--'''-'--_--_''-'�'--._-'-- � <br /> . . <br /> ���������'������'��''��_��������������''�_���'���''���������-�������������'����- <br /> ' prep6ed this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,~ State laws, andAules and regulations of the ~~. JoaquinHealth. ^.°~` ~~." District. <br /> . <br /> ~^ ` <br /> ` <br /> (Signed)_��Zgte_4' -'''_-`''--''--'��� ''�---'`''_'''`-.-,_'. and/or Contractor) <br /> �.o <br /> ` ' � <br /> By:---------------'--r---','--''---''---''---''-''---''''--'''---(// ----------------------------------------------- ------- '—' � <br /> of lot, | of-system in relation to wells, buildings. <br /> �RR DEPARTMENT USE ONLY' <br /> | <br /> / <br /> ' ArruC°/.wn ACCEPTED BY <br /> Alte�afi ns andAGr recommendations- :Q� ------ -------------------------------------------------------------------------------------------------------------------------- <br /> -------- -- --------A., ---------- ---------------- - -------- <br /> / <br /> T 7 <br /> .- -^~.__-'~�...~.-�.^-------------- <br /> ----------- <br /> ...~..'.�...-.~-�~^.^.^_.-~. ) <br /> -_._;�a�-4�+mco�.--� --- _C1 --------------------------------------- -------- <br /> Date <br /> �J ^~ ' <br /> . ) <br /> � �N/\L INSPECTION BY�''''. '''---'''-''''-' Du+�--'( �� '''-''-''--'--'-''- ' <br /> | <br /> 5AN JOAQU|N LOCAL HEALTH DISTRICT / <br /> mo c*"fh American Street mmWest Oak Street 132 Sycamore Street 814 North "C" Street � <br /> Stockton, California Lodi, California Manteca, California ` rmov. California <br /> ES-9-2M Revisea 1.57 EP.CO. | <br />