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APPLICATION FOR SANITATION' PER "IT' Permit No. <br /> in Duplicate) <br /> Application is hereby made to the San I Joaquin Local Health District for I a permit to construct a sfall the work �erein clescribed�. <br /> This application is made in compliance with County OrdinancelIGN8. 5 9. <br /> Phone <br /> ~~~ ' ~~~'`^~- ' 4----------- ----------- --------------------------------------------- ' <br /> -� <br /> -Owner's Name . <br /> '"^"'"^~—��=—'1— nz� _ <br /> �+or N _� - �p ��m� Hnuse [� Commercial [� Trailer Court Other <br /> |n�m�Go' will serve: Re�6nn�� <br /> Number nfliving units: bedrooms <br /> umber 6e6rvomuJ... Number of oarn J--- Lot ,�� --------------------- <br /> Water <br /> __._--Woter Supply. Public xym " /Community |' <br /> ,y,�,m �] �r�o+� �� Deot +� Water Table '-'' ft <br /> Character of soil toodepth of 3 feet: S d Gravel El Sandy �uyL�m �] C|uy [] ��obe��H��ponE] <br /> Previous Application Made: Yes F1 Nn � PNew� Construction. Yes E? No LJ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if Public sewer is available within 200 fee+.) <br /> D;s[ance from nearest w 1�__ A&Distance from foundation- Distance to nearest lot i7j---- ------ <br /> �� Number u| lines----------- �� �ucn xne----- .,."... of ..=^.. ^~ + -----_. <br /> ~~ Type of filter muteri�~� vp+h of filter mofarinL.-'I�yl-.--.�7ot,| |engfh_-��._0---___----.Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot f <br /> | <br /> --------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordan�e with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing si.ze of lot, location of system in relation to wells, buildings, etc., can be placed cin reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------- <br />� REV|EVVED DATE---,k5 <br /> � <br /> BU|LD|N� PERMIT |33U��-- %.�'''--'_--'-' ",.E_ <br /> A|h:,mtvns and/or <br />� ,nvvmmondahons-------------_---------_--------___---__. _-_.____.____._____. <br /> _---_------_------- '___—______ <br /> '_��—___.__..__.—___—_�_--__--_---_—�—._�_.—._ <br /> ___________________'-__—''1—_—'�''--'—'---'''- '-''--'--''---''-----''---'--'--'---�'--'''----'- <br /> . <br /> —.__-_—_----__—_--_—�—._�'_�—�—�__---_---'_-------_—_///__'—/ <br /> —'_._—_--___._'—��--- <br /> ----_--_''_—'---�--'''-_--'�'--_'—_--�'—_--' ----'''—'''—''-'—_-''_—'--''---'_--'--_'_--_--' <br /> A ._____�uf�--. .__--_—_—_�N \L INSPECTION BY.'—''' — —''—_ _. <br /> SANJOAQU|NLOCALH£ALTMDIS7RICJ <br /> ` <br /> ` /xv s""m Am°,/""" Street 300 West Oak Street mz s'ca*"= Street � x/* North ^C^ Street <br /> ' <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> � <br /> ES-9-2M 8a/ n^.ioa vv-2/00 <br /> " <br />