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APPLICATION FOR SANITATION PERMIT Permit No. <br /> ` <br /> %��mp|wf� yn Dup||��f�) �-y-�/'' /���'/ <br /> ` Du+o Issued <br /> Application is hereby mu6n to the San Joaquin Local Health D|sfrict for u ponn|t to construct and install the ,k herein described. <br /> ' T6isopp|icotion is made in comp(iunrawith County Ordinance No. 549. <br /> ' � <br /> o��o r`uunESu my m '^m�..--+^...�~�n���*...^x�^�e��.. .��^--- <br /> Owner's Nome. ����x�c�o=°. �d�w���� P�ono ' ' <br /> ----------- <br /> Address----- ^� .. -'��..��.-- -.-_--.---_____.____.___________.____________--------------------- <br /> Contractor's Nume./I68.?~�.'-------- -------------------------------------------------------------------------------------------------------------- Phone--------------------- ----- <br /> |nstaUa6unwill serve: Residence L.� Apartment House Commercial [] Trailer Court L] Motel [] ' Other [] <br /> � � � <br /> Number ufliving units: ..L.. Number ofbedrooms .��- Num6or of 6uH`s -�.- Lot size _'fc/$m.x10C1%AAo0----------------------------- <br /> Water Supply; Public system E] Community system [] Private Rj Depth to Wafer Table ff. <br /> Character of soil to m depth of feet: Sand El Gravel E] Sandy Loom E] Clay Loom & Clay [] Adobe El Hardpan [] <br /> Previous Application Made: Yo, [] No DR New Construction: Yes E] No [Z FHA/VA. Yes E] No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Nm septic tank m,mompmn| permitted if public sewer is mvm||mb|e within 200 feet.) <br /> Septic Tank: Distance from neun,x+ w6L -� <br /> .� nv-----Distance from fouvdu+ion-j(P..�--��u+=rio|. ------_._ <br /> No. of compartments- � - ---- �.� <br /> .. � . .�ip:. -'?�-- �y� <br /> ��. 'Ljqui6 Jep+�--$-------------------Cap'ci+y.."pdv----------- <br /> Disposal Field: Distance from nearest welf_�_P ^ from foundation_-'_0^ a-47. <br /> �� Number of |��, -w�� k Length of ��Z� <br /> ' Typo of filter mate rio|_4�/IV^����.Depth of filter material ..14F-"_-To+o| length----j�..AX4-----.----- <br /> Seepmgo Pit: Distance to nearest well---- M----------- from foundation..-|-P--------Distance tq |ino.10 -- <br /> K Number of pits ]L Lining te Diameter---A?- Depth-19 <br /> Cesspoo|: Distance-from nearest well-----------------Distance from fuundoHon-----^._Uning material .--------_-/ � <br /> � nempdning onvvp, rrpomng (describe):--'''--_'''-'''-'--__-'__-'-_.-_'-_______________________ <br /> _'-___-___ ---------------------------------------------------------------------------------------------------------------------.-- -------------------------------- � <br /> --------------------------------------------------------------------------------------------------------------------------------------------- <br /> ____________________________'__________'________'_______________________'____'_________�_ �_ <br /> | herem+ | have prepared this application and thatthe work *;U be 6 in accordancewith Su Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing SiZG Of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> ' <br /> 49 <br /> _ <br /> FOR DEPARTMENT USE ONLY <br /> KEY|EVVED BY------------------------------- -------------------------------------------------------------------------------------------- DATE-------_-_--___.______ <br />� BU|LD|NG PERMIT |SSUED---_._--.-_---._-__.__--__--_-.-.. DATE---------------------_._--.__.___ <br />' Alto,wMwns and/or recommendations--------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------- ---------------------------------- -````---``-----------------------------------------'-------------- <br /> - <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----`----``------------'``---````` �```---````-- ----`--`�����`�����-- ----```------'```-----``---``---``---``--���` <br /> �� �� � � <br /> FINAL INSPECTIONBY�~��� -.------- Du��e.ox-.���--------------.--.------ <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> mo s^om xm°,ico^ Street 300 West Oak Street /32 svmmvm Street ow worth ^c' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />