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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hena6v mode to the San Joaquin Local Health District for o permit to construct and in work herein described. This application is��'6 in compliancewith County Ordinance No 549 /-7/ <J�� i I -cx- |nstaUatiwn will serve: Residence Y Apartment House [-] Cumnnorc|o| [] Trailer Court E] Motel E] C}tkor El � c�-�J Number of living units: 2Number of bedrooms F� Number of baths El �Lnt size------- Water Supply: Public system 0q Community system [-1 Private [] . Character ufsoil to a depth of 3 feet: Sand F] Gravel [] Sandy Loam Clay Loam E] Clay E] Adobe O� Ho,6puo D TYPE OFINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer bavailable within 200 feet.) Septic Tank: Distance from neoresf *eU- v - from f �nduti . ' ,-_� � aterial �nt .. -- � �---��e..�� -.L|qui66op+�-_.. ��---No. ofcompo,+m - � « � � Cesspool: Distance from no�rcotveU-_-_-Distnncefrvm f�un6otion------�Lining muferiuL-------.-----�_-- _ [] � Size: Diameter--------------------------------------Depth------------------.---- ' : Distance from nearest well-------------------------------------------------Distance from nearest building-------.-_----'_- `^ [� Oistoncu to nearest |o+ Unu--__---._�-_-.__ � 'Svopoge Pit: Distance to nearest *eL----_-Dis+once from foundation--------------------Distance to nearest lot line_.___- � El Number of pits----------------------Lining mo+e6ai-----------------------Size: Diameter.._ ----------------Depth--------------------------------- " . Disposal F��6� Distance from nanny�� veU_��.__Dl�ance from foundot�n-��__-Di�anoo to nov,ns �tknu...��._`- - Length ch |� ��' �� trench- ��w*° Number of |�n � a� no_-. - ,--_--_-_ Type of filter mote ria�_- Depth of filter material------- Remodelingand/or repairing (Jescri6e):-------------------------------------------------------------------------------------------------------------------------------------------------------- , --------------------.---------------------------------------------------------------------------------------------------.---------------------------------------------------------- -------------------------------- ^ --'__---'---_-------_--------.---'--------------_--.---.--.----------_.-----'_---------'_--_.___ _ / , _-_-_-.___.--__._--.--__--..___.--___.--_---_--_---_- ----_-.--__-__--____-_-__.._-_. � I hereby certify that I have red this application and that the work will be done in accordance with San Joaquin County ordinances, State laVws, a,, rule and gulaflonis of the San Joaquin Local Health District. (Signed)------e:---- - !-�; - ----- ------- --------------------------------------------------------------------- tractor ^ (Plmt plans, showing size of|n+, location of system in relation to web, buildings. n+c . must be filed with this application). FOR DEPARTMENT USE ONLY _ r � APPLICATION ACCEPTED BY ' '7 � ' = � ' DATE ' — -__.- 'REV|EWED 8l------------------------------- --------------------------------------------------------------------------------------------- DATE----------------------------------------' QU|LD|NGPEKM|T |3SUE[L'_---'__--------'_-_.--_...--.-_�--------' DATE DA TE---_' -------_-_-'--_----' Altomtionsmn6/mrronomm*ndafiono:'---.--�_--.-----'---------.-------___-'---___-'--_.___.___________. ---'_-----------_-.-----_----_-------------.-------_-'--_----_--'____-----------.--_----_ .-_--_-_-____.___---__---_-_._--__----__---_-..__'___-__-.-__-__-'----_-_-.____._ _--_-__'''--___'''-_-''-__.'-'_-_-'---__-'''--�_-------''''___-''-_'''_-' ''''''_---_''-_-_---' -__.__--._____- ' __.__-_--._--� i ~ x ' T|ONpER �|T N } `'� � - ISSUED E ' / Date----------------_- ---- ------1'7'��---------' SAN J{}AQU|NLOCAL HEALTH DISTRICT 13¢ South American Street Stockton, California �� aS--v-2w v'so vv'/639 r `