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APPLICATION FOR SANITATION PERMIT Permit No. <br /> k�umo�tm �n � <br /> " `- '`-- --''--'` Date |ouo6 <br /> ' hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein described. <br /> This application ismade |ncompliance with County {}r&nonoa No. 549. <br /> --- <br /> Installation will serve: Residence P�r/\pur+mont House E] Commercial E] TruUa, Court 0 Motel E] Other E] � <br /> Number of living units: Number of bedrooms -!~~Number of both, J-- Lot sloy� -.��.��.��-��-�.�.��-°~-.---. <br /> u��� | <br /> �� , Supply: Pu�|�: nm [ Communitysystemsystem -E]y �m � P6v +�J�` Depth +o ��torTu6|� _�� 8` ! <br /> Character of soil to m depth of 3 feet: Sand [] E)puve| E] Sandy Loam [] Clay Loom E] Clay El Adobe Hardpan [] <br /> Previous Application k4u6o: Yo, E] No Wf New Construction: Yo No [j , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (Nm septic tank or cesspool permitted if ��L .sewer isavailable within 200 feet.) <br /> �Se nk: Dis|anco from neo,osfwe8D � <br /> � .No. ofcomportmvnf,-2�-.---- Size. � Vigui6 depth.. ".� - Copa ii -40- <br /> Disposal <br /> &0- <br /> Dispn` | <br /> Field: Dis| "cu from nearest weU------------------Distance from foundation_------------------Distance to nearest lot line'_....__ � «� <br />' El Number of Unos'-'''------------------------Length of each lime------------------------------Width of trench'''--''-'--'_-- <br />' Type of filter material '� Duof' of filter moteruL--_-...� 7vfo| length-'.__.____----^ <br /> -' <br /> 3oep�ge Pit: Distance to nearest weU.100x', <br /> - -- /--------------- <br /> nearest |ot |inv.-;�_-.- <br /> Number ofpits-­Z-''-----Uning materia ''Size: D|umetuc4�iDepth----m2 ---------------- <br /> Cesspool: Distance from nearest well-----------------Distance 6nm foun6at�on--------------------Lining motvriuL---_-.--.---.-_- <br />| 1-1 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Cupacit+--__-__�--.guls. <br />/ <br /> Privy: Distance from nearest well .------_----._--Didannv from n�°"v� �wJ��g._--__---_----_ K~ <br />\ � � <br /> [� <br /> Distance to nearest |u+ Snn.'----''-_--�'''''���'�-_-'----_'-'-''_-.'_--''__.--'-'---_'----' <br />/ Romo6o|ing and/or repairing /6vscri6n\:--------------------------M -'-]\ '--_--__..___.-___.-_--.___.._- <br /> ------'---------------------------------------------'--------'���------'----`�����--``-- ------- ------------------------------------------ <br /> ___-__-_._'_._._._____-.___--___.-- __ ---__--_.�-'_-_-__-_'---_-.__-- <br /> -- - --- --- -------------------------------------'-- ----------`------ ------- <br /> I hereby certify t at I ave p pared fhi���icz;fion nda that the work will be done in accordance with San Joaquin County <br /> ordinances. Sfa 1. s, ndrules a d ri thGjJoaquin ocal Health District. <br /> or <br /> (Plot pl -7, ,elltion to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATI ON ACCEPTED BY------------------------------------------ ------- -W- ��---------------------------------- DATE--- -------- <br /> Alte,mtionsmn6/or ,ecommro6a+ions:------------------ ----------- ----------------__'_----_---._-__._____-_--__.-_-_--. <br /> ---`--------`'--````-```--''--'-`--------------'--`------`---`````--------------'`--- <br />| '—'----'--'--------------'-'--------'-----�----'--'---'—'---------------------- <br /> --'-----'''----''''-'---''''-''''--''-''-----''''-----'''''''''-'''-'-'''--------'''-------''--- <br /> U '-----'---'-------------------------------- -------'----'' -------'' <br />' <br />' FIN/\L INSPECTION BY:-.--�",�� ----------------------------- Doto---^--' ------------------------------------------------------ <br /> SAN <br /> ^-------------..__--___- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br />[ <br /> 130 South American Street 3ooWest Oak Street /oc Sycamore Street ow North "C" Street <br />| <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> eS-9�-2w 9-5/ Revised W-2100 <br />