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. ` MR OFFICE USE/ APPLICATION FOR SANITATION PERMIT Permit No ' ~ (Complete in Duplicate) 1 Bu+o IonmaJ - This permit Expires 1 Year From Date Issued -- Application is hereby '� - to the� San I Joaquin Locu Health Dist rict for o ponn ittoconotrwcfnnd install the work herein 6oscri1ed. applicationThis in compliance with County No. 549 ` ^ i � ��7 (�� . ^ -__-_________.______.__ ` JOB ADDRESS �� U3C�||��N'''��'^�'��'--'-��--�'�«^��-'+�-`�`---------'' '---' - "� � �FNE \� � � - i � . Phone// Owns�sNomm-- . . -._' _--,c -�..-_./°_�^- Address------------_----------- -------------------------------------------------------------- -------------------------------------------- - h/azU. ^-�_.- / V _ Phone. Con �cfo/s Nmma.--D. A�`.Pmg�ei. ._ - �� Other 11 Installation �� -��once 2g A�r�e� H�� Commercial � Tm�� [] - -' Number nfliving units: ._.. Number cfbedrooms I-. Number of`baths A---- Lot ' - Deotx Water Supply: p�� system IRI m�� m D ��'� � � Vute, Table b ft Character of soil to a depth w�@ feet11 Smnd LJ Gravel F1 Sandy Loam El Clay Loam 10 Clay E] Adobe Hardpan Y New Construction: Yes [] 'No�i 0FH' ,/VA. Yee 0 No Previous Application Made: (if y=s'6ate--------------------) No [0 TYPE � INSTALLAT\ON AND SPECIFICATIONS: Om��h�n^�� feet.)i �mpt� tank or cesspool pei�i�ed � public sewer is mva | _ . '-_.---Mutn�ml _-''_-----._-.-__. - D|�unca m, �uno Septic Tank: Distance from nearestwell ' Liquid depth�� ..Cup�cHy----------------------- E] -. - LJ No. of compartments ' � -`5�n'-__ -�_--_.--- \ line.... Disposal Field: Distance from nearest well-I'VOKIF'_Distance from founclatio ----Distance to nearest lot 06 Type of filter m t _1Zr_C*1e---------Depth of filter m 1 ° �Distance ' - � 3m�Pmg* p|t Distance to naun*� well''�rqzDistance . - -,_ ^ _' uu ^ Num6orof pits----------^'''-Lining material � ,u � Size: Cso,meter-_31-.1° Don+��- - ---------- on -_ on Co,qp""'' Distance 6�m nearest w�| Distance f�� mn6o� -',-.'�'-Uningmuterial-------------------------------------- Size: '--'--'----- Size: Diam=+uc--''''----'-''-uepr" -_'''�-----.--__-_Liquid Capacity __-'-'---gals- ' al~� fnn nouro, 6uU6�g'_-_-___.'-'-_- --------- Privy- Distance from nearest well Distance Distance to nomnn,r m. """----------------- ----------------- ------------__ ..__. _____ _______________________. Remodeling and/or repairing (describe):-------- -'^ ------- k--''-'-------- ________.___.___._.__-._L_----''--',---'--''--''--''--''--''-''--' | '' ' ---'___'-'^---------'-'---'�--'-__ ___________________--_-. _-''' -----'�'- — -------�--'-----'--''------'- � = ''.. �ca ti^on_.__ _---_ - - --------- '----'-------------�-------'_ and-that the _wow3 be done in accordance with San Joaquin County 1 hereby certify that I have prepared this app ~ regulations of theJoaquin ordinances, State laws, and rule's an ` ,y; "" ., relation .~ .~ . - ��` . placed(Plot plan, showing size of lot, /oca�� --- DATE--. _ R DEPARTMENT-USE ONLY ��.�z\PPUC� ON �CCDTEB -Y -�/'� ---- REVIEWED 8Y'----.- r --_.-, _-.---.----'_--- ' ''--'-� D�TE--'--`---'--'--''- --'-' ' . DATE_'---_.'-'-'-'-''________ 8U|LD|NGPERM|T ISSUED.-__''�----.-_.'_ / --'----'' m*L |mSPu.//cw u.� -______________.-_;__ SAN JOAQU|NLOCAL H6A�H ��CT 130 South American street mxwW°*Oak o=°� 1x*wv�m"�S,�m op5West 9�o�°° ' �"m/ m"x �v",^ m""� CaliforniaCalifornia "�.m� "/" r ",.�� Stockton,California . ' cs p ncwsEo 8-59 zw �,�c *«u*a ' / z ^ ~ .