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� .APPLICATION FOR SANITATION PERMIT Permit _ . (Complete� Duplicate) Du+a /ssmo6�/0� hereby mad e nad= +o the Sun Joaquin Local Health Disfrict for a permifi to construct and install the work herein iE application is made in compliance with County Ordi nce No. 549. - -_.. �Cpnnncnn o mome-- _ -.- � --._ � _-------------------_. Phone-' ' ' ! ----'------ �� *0 serve: Residence [L-�,��artment House E] Commercial Water Supply: Public system ommunity system E] Private [] Depth to Wafer Table -------- ff. Character of s". o " depth w3 Sand E] Gravel E] Sandy Loam E] umyL�mU C|� U 8do� 2� Hu��n . � . Previous Application K4a6o: Yes E] No El New Construction: Yo, [] No E] . TYPE OF INSTALLATION AND SP '|F|CATIONS; (No septic tank or cesspool po,;n(Hif public sewer is available within 200 feet.) Septic' Tnnk: Distance from neu/rnstvo|L----Distance from foundation-------------------Material -----__________ . [] No. of pvmpo,hno�ts------ ------- -----------Size--------------------------------Liquid 6opjh------------------------Capacity_------ Di, ' | Field: Disfonce from nearest ^m|L---�--Disf*nce from foundation--------------------Distance to nearest lot ||no-- __ � [] Number of |�os 'l '-''Leng+ ofeach�Uno_----''�-''—��dH` of �ench'_------.--. . . _ Typo of filter mate rioL--'''-''--Depth of filter material '---_'---''Total length--'-'-__-'-__--__ � 3eopuge Pit; Distance |o no6n,sf well----------------------Distance from foundation---- ---------------Distance to nearest | ~|i*e----------------- F-1' Number of pits-'!_'''—Lining material-----------------------Size: Diameter--_--''--Depth''-''--_-__- Cesspool: Distance from neo�e` weU--'_--Di�anco from foundation---'—.'-Lining mote�uL-''-'''_---__ \/ Size. Diameter'----f'-'''-''-_--Depth--------------------------------------''''�-Liquid Capacity----------------------------gals.Priv . _ Distance from nearest weU---------- ------ ------ ------------------------Distance from nearest '-''-''—''--�---''-----'-6-u'i|6'-lng'--'---._-'-'-.—._—__--_—_�_ D | ----------------------------- Remodeling �� ''-'' Remo6eling ^ and/or -- -- �.__- __''--_-_----'~_'-~' '- �~~~~ ------------------------------------------ ------- ---------------------------------------------------------------- .---------------------- ----------~----------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------__-------------------------'---'-------''------''------'---------------------------------------------'��---'-------------' | hereby certify that I have prepared this application and that the work will be done in accordance with Sun Joaquin Countyardinancesi �Iale laws, and rules and regulations of the San Joaquin Local Health District. - p/en�o/-_- ^��'^��^��°�-_�-��.^�,n=u��..^�/�~�«c�a��----------_---------�Owno, mn6/*, <�mn�actp� `8v:--------------- '''-�_--___..`_,.___________._______._� ' --------------------------------------------------------- (Plot __._ ___________.- �� ^ ��ng s� of lot, ��'� ��m � relation to wells, �� c� be placed_ � �� 6d� ` ' 4 FOR DEPARTMENT USE ONLY ^''L'C"''° "�~^''�° "' u�/�- '` -'''-'`''-- -'---'--''--''---'`-''' '--��/f --'--'- REVIEWED BY._---_--_-_---.`----..�----------------- ------------------ _''--''---''' DATE''-'��!_� �/_�_7------------- BUILDING PERMIT ISSUED------------------- '''_-''v-'------------ ---------------------------------------- OATE--''-'-_--'-''---'____�__ Alteration's and/or recmmmeo6afions:--------------- --------------------------------------------- ------------------------------------------ _.-_-_._______�____ ''_--'-----_-''--''-_''-''''`-''--''---_'''--''-_.-'__.''-_''---'---''-''_-''--'-_''_-.-_'-'--. '---!------------------------- --------------------------- �--------------- ----------------------------------------------------------------------------- '---------------------------------------------------------- , ~ ------------------ ---------------------------------------- ----------------------------------------------- -------------------------------- ----------------------------------''-'''-'-'--''--' ---------------------------------- ------ --------------------------------------------- ------------------------------------------------------- -------------------------------------------------------------------------- � FINAL INSPECTION' BY:----'''' .-- ---------------------------------- Date--------/c��_--..�7.. �v.. ________SAN JOAQWN LOCAL HEALTH DISTRICT / 130 South American Street soo vvom Oak stroov /»z Sycamore Street ow North ^C^ $vm° Stockton, California l Lod/. California Manteca, California T="v. California � e»-9-2w u°./sea vv-2/00