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~ APPLICATION FOR SANITATION PERMIT - (Complete in Duplicate) /\T��ation is hereby made to the San Joaquin Local Heo|H` Diofr;ct for o permit tnconstruct and insfuU the work herein described. application made in compliance w�fhCovn+y Ordinance No. 549. ^�� J�J8 ADDRESS AND LOCATION---------------------------�7_.. �'��J#�K��J��.-' E�' /.��-.�^�«� ��_� �*� uwoers nmmo-*�~�'^�-,c°`x-u°e��_--»,�x'�--''�.�'x��=��-------.-------------- Phone--^^-'...-.. -,�.. -7- Address-------3-1.5------------40- . ___._________________________________ Conf,ucfor's Nome-_ --'�/.-... --jo------------------------------------------------- Phone-------�5?9z'-?� m�~� Installation wD| Residence R--0A H Commercial Trailer C Motel [] Other Number of living units: $/, umber of bedrooms 9- Number of baths t Lot size--------- --------------------- Water Supply: Public system M Community system E] Private E] Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam El Clay Loam El Clay El Adobe 01� Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----—----Distance from foundation------ ---------- RA.— No. of compartments----------- -------Capacity---e--0a--6A6i --4---X-- ------------i- F] Size: Diameter-------------------------------------- ---_-__--.--_-_.___- Privv. Distance from nearest well '�-_'_^------------------------------Distance from nearest building'-_.-''-'_-''--''-' ~ . El Distance to nearest |nf |ine--'-_-._.._----.---__- v ` Speppgn Pit: ^~ 5 Number of pit_'__-____.'_-n= --__ --------------- Disposal � Dispo, | Field: Distance fn,mfou ` Number of lines_-'-�---'''-_-Length of each H` oftnvnch--- '--- Typm of filter materi a| Depth of filter mmtoriaL_.?'V........ Remodeling ^n6/or repairing (describe):------''---'--'''-''_-''___--_--'''_-`_______________________.____. -` ----------�-'--------'-------------'---------------'-----------------------------------'----- �p ----------------------------- -----------------------------------------------------------------------------------------------------------------------::------------ -------''--'----'--'' ------_--------_------_-----------------____--------'___---------___-----_------------___------'---______---____-----------__-----_-----___-----------_---------_------_----_-----_------ l hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State s, an es ions (Signed).-, ---------------------------------------�-I-r---------------100-V,000/v---f-�------------------------------------------------(Owner and/or Contractor) ` "r^-------'' ----'-----------'--------'------''--('nle)---'--'—'---'---------' (Plot plans, showing size of lot, location of system in relafion to wells, buildings, ate., must be filed with this applicaflon). - ^ ' FOR DEPAliTk42NT USE ONLY _'__-_--___.''---_-'''_-,-___''--___'-'''-_-'''-__-''--__.'''---___-'''____._____--_-------' --_--__-__--___.--..___----___-----__---___----_-._.___--._--_--___'--_----.. -----------------'`------``````------'`````--------'`````---------`��`-----------`�```------'--``-----------```------------``----'------'--------------------------`--------------'-----' -'--_-'__-''___-'--__''''''- __-'-----_.-'''�'-_-'''-'---''''----_-'_-'--'__.' _~ - PERMIT No.. �.��-.. |S3UED.-. �-�-.(Dufe) FINAL INSPECTION BY�--'��. ` ..`�..��'�-��'�`" � ___ ~ Do+p---��--_�-.~^ ' -------------- SAN ----SAN JOAQU|N LOCAL HEALTH DISTRICT 130 South American Street Stockton, California es-9-2w v'oo e^/+m