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---'''�' ���7� ' ^ - <br /> APPLICATION FOR ���� <br /> ~~ � SANITATION PERMIT �nm� �� -�� L1 <br /> ���o�� � �w�u��� /�_� <br /> (Complete Duplicate) 0mfo |suwmd -.--�'��'��x/ <br /> Application |ohereby made to the San Joaquin Local Health District for wpermit toconstruct and install the*o' 1-2 |- <br /> This application is made compliance with County OrdiNo. 549 <br /> J01'-~ "'ADDRE --' -~ ----' '-'SS AND 4�-d <br /> Owners Name r-- ---._.------..._--------. Phone................................. <br /> - <br /> Address --.-'-...-'---- <br /> °""'""~" s '`a""^---''. _----..__--_-..__.---__.__.__-_ rnone.................................. <br /> Installation will serve: Residence rtmentHouse 0 Commercial C] Trailer Court (3 Motel [3 Other [] <br /> Number of living units: -��- Number of 6m6,uoms :�- Nwm6a, of baths --e--- Lot size .^*��- ��-���- -_ <br /> ' ' <br /> ��� <br /> Water Supply: Pu6||u system ��CommunH� system I-] Private [] Depth YVnterTu6|u .��'�n, <br /> J <br /> Character of Will Gravel���t� of feet: Sand [] ,�ve| [] Sandy Loam E] Clay Loam E] C|*y [] Adobe rdpun [] <br /> Previous Application Made: (if yes,date--------------------) No REt' New Construction: Yes 2f'No [] pHA/VA. Yws C] Np@E�~ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fmnh or cesspool permitted if pub8woewer ;s available within 200 feet.) <br /> � <br /> 6o k: Distance from no D ' '��J---.�W �� <br /> MO- No. o{ cumpurhmeots.~�N�_---.. .����D�}L�ui6 � ��"...........Cupu '- ' <br /> Disposal F��: Distance -J~ <br /> QQr" Number ofeoch offmmc�.. 241 p~--------- ............. <br /> Tvoa of filter mofor�|�� of filter material ^'-Totu �nofh' -_-Seepage "~ <br /> � ^ Rt Distance to ��� � --- --'----�- '---'� � | �r <br /> `� Number of ��� �--- Unng _ � <br /> � <br /> [' <br /> Coxqpoo : Distance from nearest woL----D|stanco from foundation--------------------Lining mufer�iuL--'_'-_.__ <br /> [] Size: Diameter--------------------------- ---- ----------------------------------------------------Liqvic! Capacity-----------------------------gals. <br /> Privy:� Distance from neu,o, well------------------------------------------ from nearest building---------------- -_-_---- <br /> [] Distance +onearest lot line--------------------------------------------------- <br /> Remodeling <br /> __RemmJel|ng and/or repairing (Joscr�6eL---.x����*�,��' �~��°�����������................................................... <br /> . . ° �-^�___ � <br /> .................-_. -------------------------------------------------------------. -----------------------------------------------------------------------------------------------------------------------....... <br /> — \ <br /> ............................................................------------------------------------------------------------------------ ----------------------------------------------------------------------------- ---------- <br /> ------------------------'-------'--------''-''-----------'---'---------'---'''------------------'' <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stafe laws, and rules and regulations of the San Joaquin Local Health Disfrict. <br /> — ----- ------- --- -----------------r------------------------------------------------------------------(Ownep Contractor)(Plot plan, showing size of lot, location of system;' e�lifitnfo wells, buildings, etc., can be placed on reverse side) <br /> FOR DEPARTMENT USE ONLY <br /> --'''' 7�-''— ' --' -----'--''------'--- <br /> ~^ '--'"�°~—'��°`- '=��'fw«�«�-�,~f^'+- -''- �-��/'-----_.._-__-._--._' <br /> _'--'-''---'-'---'---'''--''--'''-----''-'''''_--'_-_--_-'__--_-_-'-_.---.'''-''-'_-'_-.'--- <br /> '._--.-._---------------._-----_-.-_----_---_---_-._--_.---_--------'----.. <br /> --'''--''--'-----'''''--''--''--'--''--'''-'''-'''-'''------'''—'-----''-'-''-''-'''-''-'-' <br /> ' <br /> -~7 <br /> RNAL INSPECTION BY:-.' �'� �u��- �����-~7 ..�� � 7_____-.__ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street n00West Oak Street v2oSycamore Street uoxWest v1hStreet <br /> Stockton,California Lodi,California Manteca,California n"xv,c"/n"rnia <br /> ,o 9 REVISED B-59 nwa'mATLAS <br />