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� <br /> APPLICATION FOR SANITATION PERMIT Permit No. 'l <br /> _ in Duplicate) Du+a Issued - <br /> Ano||cu�on 'is kera6v made to the 6an^Joequin Local Health District for o permit +n construct and in�o||the work herein described.rh|' application is made in compliance with County {},d|nonca No. 549. <br /> 4 <br /> .~. ADDRESS A'�� - - _-~-� �� <br /> ------- <br /> Owner'sName �r V _ <br /> _ <br /> ___. � <br /> -d--SContractor's N ' _______ <br /> |nd=|�HonwU' mon/w: Residence / po�mrn+� ouo� [� Commercial [ Trailer Court [] Motel�[I Other -- <br /> Number ofliving units: . um6erofbedrooms -~�-" um6erc4 botks -y-' Lot s�a _-� � . ..w ....Z--..d ............... ' <br /> � Water Supply: �Pu6|ic ,y5tam .[] Community system [] Private [] Depth to Wafer ToW° -------- FL <br /> ' Character of sail foa depth of3 feet: Sand E] Gravel 0 SandyLoamEl ClayLoam [] Clay Ej Adobe[] Hardpan � <br /> Previous Application K4a6e; Yes E] No El New Construction: Yes E] No E] <br /> ` <br /> TYPE OF INSTALLATION AND 'SPECIFICATIONS: _ <br /> (N* septic tank p, cesspool permitted if public sewer isavailable within 200fowt) <br /> 3iptic Tank: Distance from nearest well -----Distance from foundation--------------------Material ----------_----- <br /> ' ` [] No. of compartments---------------.Size--------------------------------Liquid <br /> 6up+k--------..Cupucity------------------------ <br /> Disposal <br /> -----�--_' <br /> Di, | Field: Distance from nearest weU---_'Didnno, from foun6u�o�.---._.-Di�ancn to nwona� �t line----------------- <br /> Number <br /> _-_-. <br /> N m6or of |�a� Length � each |�n ' ��h of french----------------------------------- <br /> T <br /> � <br /> Tvoe � ��er� mmf�r�L'''--'�-Doot of filter material -'---^-'70tm| length-------------------.'''------ <br /> we| *� ^ D ° � / <br /> 3u Pit: <br /> ` <br /> Cesspool:x f <br /> u/mnnnn from nearest °".^'''--'''D.,.".^= from foundation-_''---.,,.g ..~....________________ <br /> ` -- <br /> Size: Diameter-- ��pudh�'--'''-�-_-o�s <br />� Privy: Distance from nearest well-------------------------------------------------Distance from neoms+ building--_---.__-_- <br /> Dis+uncefonou,est |of |ine-'''-'''--'--'''--''-'-_.'__.'__--'_--'---'-''-'-'--'-'--- <br /> Rvmodeling on6/n, repairing (describe):------------------------------------------------------------------------------------------------------------------------___________ <br /> ---`---------`-`-`--'``--'-------'`--``-------``--'`--'----'``--``--`--``--'--``-``-`---`-`` <br /> --L_-'_---_--'-='^--------'''---''--'----'----''--''--'----'---------''------'------'' <br />� -+-----'''---� -----------------------------------------------------------------------------------------------------------------------'-_--_-'_-'-'''-'`_--'-''-^ <br />� that the work will be done in accordance with San Joaquin Cmunfy \ <br /> ordinances, Staff 1 5, a n d rules and reguloeons of the San Joapl.uin Local Health District. <br /> end�er Contractor) <br /> W�4n rei on to wells, buildings. efc., can be placed on reverse side). <br /> (Plot plan. showing size of lot. location of system i <br /> ..FOR DEPARTMENT USE ONLY <br /> Alterationsand/or recommendations: --------------------------------------------------------------------------_------------------------------------------------------------------------------ <br /> -__--_.__.__---------------------------------------- <br /> -----------'''---'-----'''-''-'''''-''---'''-''''--''--''---'''---''-''---'---''''''---'-'--''---' <br /> - ---._-._--.--._--_----.--.__-_ <br /> ----__''_'-~^~'-'-'_''''--'~-''-''''-'-'''-''''-_'----'''' <br /> . - ''--''--'--''--'''-----_'--''---.-'--. <br /> --''--'''-''--'' '-'-'-'7-�-- ' <br /> ' Do�. ��-.���. �{ <br /> FINAL INSPECTION 8Y.' ------- . ~ - - -. -_-.----'__.__ <br /> LOCAL HEALTH DISTRICT <br /> S�N JO��U|N <br /> /vv s"�� American Street 3tmWe� ��*ks*="a |ox Sycamore Street ow North "C" Street <br /> ' Stockton, <br /> `California . � Lodi, California Manteca, California Tracy, California <br />