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APPLICATION FOR SANITATION PERMIT in Duplicate) � hereby made to the 3o' Joaquin Local Health District � �m cfforu permit to indo|| fhework heredescribed.ndescribed.TGsapplication is made incompliance with Counfy Ordinance No. 549. � � »� .� JOB ADDRESS AND LDCAT| ��x_'�-."�*�x�"� --�- ---------------------------------- Owner's -----' '' '- [)wner'o Name----'{_"'--VZ'IIA7 -.------_----------------_------.----' phnne-._��Z^�'�z�e-- �mum,o---'-'_. "s�x_x - -1-3-7-6 Contractor's Name-. .��-��m�o.�,�-��.��/�.=,------------------------------------.... Phone..+Y-,4� Installation will serve: Residence N Apartment House E] Commercial Ej Trailer Court E] Motel Ej Other E] / Number of living units: -[E~ Number of bedrooms_[3 Number of 6u+h, EN--Lot -------z3j�z.--_------' Watw Supply: PubJic system W Community system [-1 Private [j - ' Character of soil to m depth of feet: Sand [] Gn,vo| [] Sandy Loam F Clay Loam []' Clay E] /\6o6e E] Hardpan [] TYPE OFINSTALLATION AND SPECIFICATIONS: . (No septic tank urcesspool permitted R public sewer lxavailable within 200 feet.) `« Septic Tank: Distance from nearest well-----------------Distance from foundation-----------------Material _--.-_------_.-_--- | F1 No. nfcompartments-------------------------Cupucity-----------------------Size--------------------------------Liquid 600f --------------------------- Cesspool: ----_-_-- : Distance from nearest wvL.___-_Distance from foundation--------------------Lining mofe6vL--_�--__.__ n Size: Diameter-__.-_-''_-__'_Depth---------------------------------------------------- ~ m Privy: D;�ance6nmneamstnv|L__---__.___----_-O�funca6nmnoanm� building---___-_-__-_-- ' [] Dis tuncetnnearest lot line---------------------------'''''-__. Saopuge P»: Distance to nearest well----------------------Distance from foundution--.------Distancoto nearest lot line---------_.-. [] Number of pits------------ --------Lining material-----------------------Size: Diameter------------------------Doofh..'--___...__-.— Oispusa| Field: Distance from naanestweUJ7xA_e_.-D*is+uncn from foundot|��--------------------Distance tonearest lot line--- Number of lines --/ Length of each line.-_-^�OO.-------Width offrench---------2___4±---------------- Type of filter mu+aHuL'd---.------/t�� -Depth offilter material------- Remodeling and/or repairing (describe): ' ---------------------------- ---------------------------- '-_______ '--------------------------------'''----''''----''------------------------'------- ------------------- -------------------------------------------------__..------------------------------------------------------------------------------------------------- ------------------- ------ _-_-________.' � __.______-_-��_-_-----___.---_-.__-___-----_..___..—.__-'-''__-__..___--__--_-'--_-- hmm preparedH`is application and that the work will be done in accordance with San Joaquin County ordinances, State laws. and rules and regulations of the San JnuquinLLoca| Health District. r� --------------------------------------------------------- (Plot plart'C�sho dg-sizo of lot, location 0 sys ern in relation to wells, lbuildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY -------------------- A|tem||nwxun6/ornocpm,nen6ations;-------.------_----_-_-_-----.------------.-._..''...-.-..___.__________ ----'-------'----------------------------'---------------------------------'------------'---' ---'---'------------------'---------------'---'------'------------------'---'-------'------' —'------'---'----''--------------''----''--'--'-`-----------------'''---`-------------'- '----'----'--�'----''---'---------'''---'—'---'-------'--'-'---''---'--'-''----'----'--'-- PERMK No''' ~ d''--- ISSUED- '___(Dete) RN/\L INSPECTION DY----------i�/ // �� '-_'-_-'-_.'-' Date----------------- --------------------------------- SAN JOAQU|N LOCAL HEALTH 0DTR[J 130 South American Street Stockton, California ' ES-7_ 2w 9-50 W-1639