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FOR OFFICE <br />� APPLICATION FOR SANITATION PERMIT Permit No. <br />(Comp��^�m��m8m ������� <br />lete - ,---' Omtm Issued -- A/ .0 <br />App|ica-tionis hereby madeto theSanJoaquin Lpcal-Heal+h District for a permit to construct and install the workherein described. <br />This application is made in compliance with County Ordinance No. 549' <br />JOB ADDRESS AND LOCATION...'--'�"-��-~ <br />---------- <br />Owner's Namo-----------.----'��.....�lj.4�w�------_-__-.-.-_.-�-.-�-�-�_e�.�-�--/�.- <br />.�.--~�.. _P'h <br />A6Jma�-'-'- ^^ -------------------'------'------' <br />Contractor's Name .......................... <br />.�.x������roono-��-/�'��'���'��'�� <br />Installation will serve: Residence N Apartment House E] Commercial 0 Trailer Court [] Motel [] Other El <br />Number ofliving units: './- Number ofbedrooms ~2. Number of baths J.- Lot size ----- -- Z310..��a�� <br />Water Supply: Public system El Community system [I Privaeg%epth to Water Table Y.57 -ft. ^ <br />Character of soil to depth of 3 feet: Sand Fj Gravel E] Sandy Loam E] Clay Loam 0 Clay '�mrdpan Fl _ <br />Previous Application Made: (If yno'6nte---- ) Nm'W New Construction: Yes 1Z No FHA/VA.Yes b No�� <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted R public sewer is availablewithin 200fe t) <br />Septic Tank: Distance from nearest ~e|12�ja ------ <br />i to ^��� ^x +e . | <br />--��m�������ez���� <br />m� No. ofcvmportmwnt,..��- <br />.-r- <br />.gzm-'�p��-��.��..j���qui6 6epf�_-��'��--.--�Copuc��--����� <br />Disposal Field: Distance from nearest weU._/��~� '----- Distance from foundation..,4q_ Distance to nearest lot line .... "��� <br />�.of N*m6a, of lin_ Length of each es 0 c�_Totui |angt�---- <br />riall_........../d��'_-__-- <br />Type of filter mu+n�_-DnpH` �� filter motoriuL���� <br />3oopogo Pit Distance to nearest well --------Distance from foundation ................... Distance tp nearest lot line ----'-- <br />[] Number of pits. -------------------- Lining mmtariuL.-_----3ize: Diomntac-__—_.--_Deofh -.__...................... <br />Cesspool: Distance from nearest weL---__-Distuncefnom foundation -------------------- Lining <br />Privy: Distance from nearest *mU-.---------------------------------------------- Distance from nearest.......................................... <br />--'---'-----'-------------------------------'-------------r-'--------'-'' <br />this and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />(Si�C/ <br />rg''~_�^^~~~-�---------°------~'---------'------------'--------''--`---- ' <br />~x..-------------------------'---- ------------------------------------------------ ----'—' <br />(Plot plan, showing size *flot, location ofsystem in relation to wells, buildings, etc., can bwplaced mnreverse oidm). <br />FOR DEPARTMENT USE ONLY <br />_ <br />`APPLC/Tl{N ACCEPTED DY- ��|-------------------------------------------- <br />REVIEWED <br />^~ —' <br />REV|EVED <br />BY -_-.--___---__-_------_--__-__--__-_oA|E . ................................................ <br />PERMITISSUED ........ ----------------------------------------------------- �.......................... ........... DATE ............................................................. <br />Alterations and/or _-'_--.--------__-___________.________________________.___ <br />----------------------------------------- .................................. __'____.. <br />-___--.............. -------------------------------------- ------------------- ------------------------------------------------------------------- ........................................................... <br />--------------------------------------- . . . _--- .-_-_-_---------------------------------------------------------------------------- <br />F|N/\L |N3P8�T|{JN 8Y ---' Dato-.-.-..�-�..,��.��-��.[�-.L�.__------. <br />S�N ]N��CAL HEALTH DISTRICT <br />~~ - ', <br />1xnSouth �*a�"S� �W��x� 1n*S��o� n�W��o� <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES -" REVISED ~3""".C". 2M~"0 <br />