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APPLICATION FOR SANITATION PERMIT (Complete in } Du licate - ' p Application isrAND a e o an oaqurn oca ea s r c ora •ermr o m e n ins This applicatiin comp) nce with County Ordinance No. 549, e +n escribed. JOB ADDRESOeATI 4` j v. t' Owner's Namet._ - , ---------- -------------- Address. - - 13i.. 1Q h �y f• __ __________ ____ Address_--------� ---- ---- ----------------------- -- ----------------------- Contractor's ----- - lne---- - -� - -- . Contractor's ame--��D�� ----------------------------------------=-�------------------------------- ---=-�--�-��',�------ Cj Instaliatioo`�wili serve: -hone_"--- ------------I-------------- cl c Ap ent House ❑ Commerciai ❑ f Trailer Court ❑ Motel Numbe of livin d.' ts' ❑ O her ❑ 9+Y+ Num r of bedro s N m er of hath Lot size_______ +` ater Supply Public }' _.'a k)31 tt% Com ity syst Priv `* —ttharacter of soil to a e feet: �� # ❑ Gravel ❑ Sand' Loam ❑ Clay Loam o Clay ❑ ' dobe l H rdpan ❑ 1 �'PE OF INS ALLATI(c� SPECIFI TIONS: 3 I (No se tic tanl�r cess l permi if public sewer is available within 200 feet.' . ;?epfic Tank Dimer f neares ll___-• '•--------- ! Distance from foundation._______E_ .. ----- Ma#erial ---------------- ------------- 4- I ❑ Nao rtments_ - CapacitY__ Size_ - ------ ��' Liquid depth _ ' r ---- I esspool: - Distance ha neares ell_________________Distance from foundation___________---�i ing material_____________ fi'! ❑ _ Si,iS: Diam t r_ " -- --------------------Depth ------------- nvy: nceneares elfDistance from.n buildin Distance narest P g------------------------- --------------- . '`tteepage Pit: Distance t arest elT------------------ Distance from foundation________________ 7t nce�ta nearest lot line_._____ ❑ Numberts---------------------Lining materia)___.---------__-- ----Size: Diameter j Dept h-----------------I------ � materia)-- ,.-Disposal Fiel Number o 'lines W � 1 istance from foundation_____�._F '� 1.0—x'" 2 L �ist-nce•to nearest-lot fine_. .;'-- - ea�„ ,ell__-- d� Dength of each line �"�, 1 T ---___ AJth o trench__ -------------------- ype of er material , AVF•17;_-Depth of filter material__14--.J� � --------------- ( RemodePi ' d/or repairm describe :- .;�--- 1 � � �. - _ ,1C------- 1 -Lei f 'q ------------ ---•- -ff� 4 ---- .� - ------------ ------ ------ f'----------------------- - -----•---- --------- . -. I hereby certify that l e prepared is application and that the work will be done i cordance with S oaqui County ordinances, S ate laws, and r e and regu tions of the San Joaquin Local Health District. ` _ (Signed)--- E'd r I Ci I .wl� r .. -----------: :------------------------------------------ {Ow_�ney and/or C ntractor) By: --------""" , - -----A---------------------(Titleq = {Plot plans, s owing size of lo# to ation of s stem in relation to wells, buildings, etc., must be d with f _ his application). S FOR DEPARTMENT.USE ONLY APPLICATI ACCEPTED - - ' pTE k -- ------------------------------------------ ----------------------BUILDING RMIT ISSUED tREVIEWEp ---------- - ---------------. Alterations a d/or recommen atons:---- f -- --- - ---- ----- - { TE ------ --- ------ ---- - I -•- ------------- ---------q- - - - ---------------------------------------------- ------------------------------------------------------------------------------------------------------------------- ----------------- - ------------:-,:--- �d `f ' --------------------------------------------- PERMIT No. (Date) FINAL--INSPECTIO --------------------------i � --------------------- ' ISSU D •�� `" -- N BY: " ---------- Date SA JOAQUI L HEALT STRI TT _ 130 South American Street E5-9-2M 9-50 W-1639 Stockton, California