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Y6\» <br /> ` APPLICATION FOR SANITATION PERMIT Permit No' ���------------ <br /> � Ouokca+e <br /> (Complete Duplicate) Issued <br /> Application <br /> �o �o,n6v mo6o to the San Joaquin Local Ho*|fh District for u purmiffoconu�uotand |n�uUthe work herein described. <br /> This application is� made in compliance with County Ordinance, <br /> --------------- <br /> 4 <br /> Commercial F] Trailer Court E] Motel_[D—Ofher E] <br /> Aparfment House <br /> Installation will serve: Residence <br /> Number of living Unj�s:(/. <br /> \mofo, Supply: Public system mmunity system E] Private LJ Dept to Wafer Table z4o rc <br /> Character nf�soil to depth *f3 feet: Sand [] Gravel E] Sandy Loam Clay Loam 0 C|n' [] Adobe un6nan [] <br /> Previous Application Made: Yes [] No R°~�Naw Construction: Ye, W?~No E] FHA/VA. Yes 0 No <br /> ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No snpNC fankorceopoo| pe,mH+n6 if public sewer bavailable within 200 feet.) <br /> Septic Tank: D i's.fance from nearesf well_69)��_'_bis'fance from foudlafion--- Material------ <br /> Disposal Field: Distance from nearlst well_tAcu-g�---Di�tf-anc6e'�rkm'foundation--./--O---1-------Distance to nearest lot <br /> Seepa�e Pit: Distance to near7f well- ------------ -------Dist�nqpfrorn founclation-LO---r-------Distance to nearest lot line-----ns7- <br /> � C°`sp |: Disfonco frcm nearest well-'----.----------- from foundation-----.---�Lining. mu+eriaL---------.--,� ' <br /> [� Size- Diameter! ----���.--------Dopth,,.`�=.��~—.----.----L--- Liquid Capacity----------------------------go|o. \. <br /> Privy- Didnnco fmm�nen,r` we|L------.--._-----..Distance from.neunys+ building---.---'__—._- '~ <br /> [Vstance to nAm,st lot line���—'''--''--'''—'''----------------------- ------------------------------------------------------------- __--- <br /> ` , ^ 4, <br /> Remodeling and/or repairing (6nscrbe):------- -------------------------------- -------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------l—._—.___'-_.___---'---'------'--------�—'-----'-----'----' <br /> '—''—'---_.__.--'—__'_-!'''—^--__'--_—'_—'''-------''''-------'------'--'-----'--'—^''--'-- <br /> --.—.__.—_—_—.—_---- _'__-----_---_-_—__-___—_—_---_---__----.---------------------- <br /> I hereby certify that I have <br /> 6iepared this applicationand that the work U be done in accordance with San Joaquin County <br /> ordinanc4o Sta-fee laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)=_-�---------------------0---�\_t�A <br /> ' (Plot planshowing size of lot. location of <br /> sys�+ in re i build in gVef c., can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> ' - <br /> APPLICATION ACCEPTED BY-----' -- —�_�_—_--._°DATE--. « � ' <br /> ---------------------- <br /> 1,13)—P <br /> _—_-- <br /> °~ n REV|EmED B� ' yDATE- �� <br /> BUILDING PBlk [T ISSUED'----�--.—_.--�� _—. . .. DATE <br /> ---------------- <br /> Alterations ' <br /> � --------- <br /> ----------------------------------- <br /> -- _p---------- --------'—'--- ----------------- <br /> ----------- <br /> —' <br /> .^---� n �.."----__-__—__--- __-_— <br /> .—_'--._—_—__---� � --.' <br /> ---''--'''—' _ .—'—_-''—''''_—'''—''--'—'--_-^_''''—'''_— ---'_—' <br /> — � �/�__ ___________._____________�_____. <br /> _---..__.- ��N� � ' —.—..4. <br /> . <br /> —' ---'-''---''—'''--''-'�_—.''—''—''--''--'—'--' <br /> � . <br /> FINAL |NSP ' Do+r —,��'���� ~ ''—'—''—''---'-''. <br /> .'~ <br /> � SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> mo s"um American Street uooWest Oak Street mx Sycamore Street m|+ North ^C^ Street <br /> Stockton. California Lodi, California Manteca, California Tr-a"v. Cu|n","ia <br /> ES-9-2M R°.is°v 1-57 rpCO. <br /> . ~ `/ <br />