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- � <br /> , ~ <br /> APPLICATION FOR SANITATION PERMIT ( <br /> l <br /> (Complete in Duplicate) \ <br /> T�plicaflon is hereby-made to the San lo�| H�|�'���d6� o p�m� +ocon��fand �s�U �e�� herein described <br /> ' <br /> ."uupFv/conom /s made m compliance UCounty ounfy [),6inoncu No. 549. ' <br /> JOB ADDRESS AND LOCATION <br /> ' t/ W~ <br /> ' Contrnctor, mome.--'��^'/��^ �� 1/���1 // <br /> - r------------------------------------------- ---------- ---------------------------------------- Phone_.�� <br /> 'aZ3 <br /> Installation will serve: Residence L] �p��men+ House � �umm��in| � Other � �i <br /> ------ <br /> Trailer �ofe| [ ' <br />. <br /> Number of living units: [l Number of bedrooms [:] Number of 6otk Lot size �^���� ����-------------- | <br /> VVafor Supply: Public sy�em --/�(�ommun�+y sy,�.m [] Private �� ' ��wY�+L' ---^- ------------------- <br /> Character of <br /> '------Cha, cfernf soil to a depth of feet: Sand El G,m/o E] Sandy Loam E] Clay Loam 0 [1oy [-] Adobe.2--Hardpan [] »& � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or oowpou| permitted R publicsewo, is mvaUu6la within 200 <br /> _ feet.) <br /> Septic Tank: Distance from nonn:,t well-&�14� D;ofonc� from foundation --- Material9 No. of comp*�manis. �� � ��-4��.L <br /> L-q-u'i6-d-a-ot--_-------------------- <br /> Cesspool: <br /> '----- <br /> CeoL�poo|: -Cupoci�/ .. S�o ' '___- <br /> Distance from oruswe -----Dio+oncefrq foundation '' ----Lining moto,io|------------------------------------- <br /> Size: Diameter---------------------------------------'- _'-_.-.------------------------------------------------------- <br /> Privy, <br /> ____�--__ '__-'''-_privv Distance from nearest well ____.__-'-_-Distanon from neo <br /> n,'t <br /> building-----:Di�ancefoneurns lot line <br /> --'--'''---'-- <br /> Seep a Pif: Distance to nearest weU - -'-----Uis+ <br /> "'=: dation--------------------Distance +onearest lot line <br /> ____._Nun6a, of pifs__-/---------------Lining <br /> material--- D/�m�foc_���.,_--_(]�pfh. �=� <br /> D�p | R�|� -- ~ �-------- <br /> ^pu^ � u��nce from nearest well----------------- <br /> from fp� � 6on- '~'` -Distance fonem,os — <br /> �t-|'line----- <br /> Number of >|n*, ' / / - <br /> - eno+ ofeo � |l � Width of french' -�-^ <br /> Type of filter mof*rio| --------Depth of filter material------- ''�^ <br /> Remo6o|ing --J-�-- <br /> '-- <br /> -'' <br /> and/or repairing ^�--�6o)�--''-_.''-�-'''-_'--''-_-'--_-''-__----_.'_-� <br /> I hereby certify that I havLq_prepired this application and that the work will be done in accordance with ,S-a-n__Joaq-On__Cou-n-f <br /> ?w ordinances, Stafell-was, and fules- nd regula+/ion; f +he S Joaquin Local Health District. <br /> (Plot plans, showing size of lot, location.of system in" relation to wells-.--buildings. etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> Alterations and/or recommendations: <br /> ------------------ <br /> ` P_-..:.'-----------~- -------- ISSUED-------- u.�����^��.� ----(uo+n) FINAL INSPECTION BY:---------------�m��--.i�-'- _ <br /> Dote'-'�___________________________.__. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> �v <br /> ` <br /> ~ (30 South American Street <br /> . Stockton, California <br /> ��-'+-zm 9-50 W-4639 <br />