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� <br /> / 7/ ) <br /> ' ^ | <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate] <br /> � � ��� �� � �e �nJ�q�n ��| Heo� D���ro �m � �n�u� o� ��aU �owo� �� ��b�. <br /> '�| is application is made incompliance with County Ordinance No. 549 <br /> JOB ADDRESS AND ^~~`^'~'` '~ '`—'--''----------'---------' <br /> Owner's n « _-_---._--..__ Phone_-__-__--_—' <br /> - Kvv�r <br /> m" - ���� ��—��------ '-----'---------- / <br /> ContractorsName---------------------------------------------------------------------------------------------------------------------------------------------- Phone---------------- __--__- <br /> |nstaUationwill serve: Residence X Apartment House F] Commercial F] Trailer Court [:] Motel [-] Otho , <br /> Number of living units: Number of bedrooms �I Number of 6n��s Q� Lot size ,��.. �-�-.o�-.---_-- <br /> -- -_ �- _. ~ ~' v " � <br /> Water Supply: Public system jj Community x>atam F1 Private Ej <br /> Character of soil to depth of feat: Sand [l Gravel [:] Sandy Loam [� Clay Loom [] C|uy [� /\do6o �� Hardpan [] <br /> ~_ - - / <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer 7savailable within 200 feet.) ' <br /> Septic Tank: Distance from nearest wnU-!!z=-------Distance from foundation <br /> ' founda+|un-' -Material-- -I �u=«-»�- 'n <br /> , w+^' <br /> No. of . Cup�c��� Ca° mt- -t------------- y ~ ------ _--'Liquid depth-----4/ <br /> _--.- <br /> _- <br /> Cos,poo|: <br /> Distance from n�une�fwe|L_---_Disfon�efmm�fovn6ution---_---�L]n|ng mufe6uL----.--.-----._ « �� <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Disposal Field: Distance from nearest well--�t�-------Distance from foundation----I-- -------Distance to nearest I-o ---------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------'-------- <br /> / <br /> _______'_________-_____________''_________ <br /> I hereby certify that I have prepared this application and ih"at.-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 /> ` <br /> (Signed) _' ----------------------------------------------------- .'-----'- and/or <br /> ............ -._ ----------------------------- ---------------------------------------------- -------------------------------------------------------------- <br /> (Plot plans, showing size oflot, location of system in relation to wells. buildings, etc., must be filed with this m <br /> 4y- $/,FOR DEPARTISAENT USE ONLY | <br /> / <br /> < <br /> APPLICATION-~- ..~, ' .~~E .E~ BY . <br /> RB8E\wB} � <br /> BU|LD|NE> PEK�{T |SSUE _' --._- DATE_-- ------------------ <br /> Alterations <br /> ____ . <br /> Alto,m+iono and/or ,ocommen6mfiono:__.-__.-.__------.__--__-___.._._____.________._.________.. <br /> --____._____.__-__----.__-_-__-._.___--.-___---.-----__---_-___.____-._____-.__.-.__.- / <br /> ------''--'------'----------'--''-----'-------------'--------''---'-------'---'--- <br /> -----'----'---'--'---'---'----------'-'---''-''''''--------'------'' <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> � �� <br /> PERMIT No--.\«�1.l-_- ISSUED--J\�-Jq.7-6---------(Oatel FIN/\L INSPECTION BY:------------------------------- <br /> Do+e_.-'''__''''�_--- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street v <br /> ' <br /> Stockton, California <br /> B-9-2w 9-50 *�1639 <br />