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V/ <br /> ` <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> R�*m�|�f� ;n Omp|��fm1 <br /> ` ' Date |osuo6 <br /> ` o| ho,e6v made fo the Sun Joaquin Local Health Di�r�tfor u permit +ocon,�uctand ;n�uUthe work herein described. <br /> 6| <br /> Tsopp||cut/on is made in compliance with County Ordinance No. 64Pv�Z1,7z <br /> �J[)B /\DDRESS N.- �� 8��� .J���--��..�� .... <br /> .-.. <br /> Owner's Name_^.�~~~=~° ^` �� Phone------------------------------------ <br /> Address.-..------ <br /> --------------------- --------------------------------________._ <br /> Contractor's Numo -' ------------------------------------------------------........ Phone------------------------ --'' <br /> tnsfmllafion will serve: Residence F?}~ ApaMmon+ House [] Commercial F] Trailer Court [] Motel [] Other [] <br /> Number ofliving units: Number vfbedrooms Number of baths size -.~���~.���`.�����-----_._ <br /> Wafer Supply, Public system [] Community system ER�_p,ivuto [] Depth to Water Table ~2A ft � <br /> Character of soil to a depth of feet: Sand E] Gm"*| [] Sandy Loam [D Clay Loam [] Clay [j /YJo6o a Hardpan [] <br /> Previous Application Made: Yes El No '�q­NowConsfruvt|nn: Yes6�� No �] <br /> --- . <br /> TYPE C}FINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool po,m7f+w6 if public sewer ivavailable within 200 feet.) ` <br /> , <br /> Septic Tank: Distance from nearest w=U.A�P.'-D|sfuno: from foundation------/,, Material-----d- -------- <br /> PS- <br /> __[mS- No. of comportmrnf,._ °�7 ---.S .������'Uqu�� �ep�k-.^u���_--.-Cupo��ty_. w����__ <br /> Disposal F;e|6: Dlstanco from noon,of U-424--Z...Distance from founduiion_A�°v�--Di�nnco to nearest �t |�e---»�"1-. <br /> 10 Number � |�n�'_'�- �� � �� �� ^� of trench / <br /> Tvpe of filter material - _54Depth of filter mm+eriuL-. .."-Totu| �no�h.._�� �-- --------- <br /> Seepage Pit D;sf nce to nearest well _--''''Distance from foundation--------------------Distance +o nearest lot line _-'--_. <br /> [] Number cfPits----- ------ -------Lining material----------------------- Diametec-'-.---..Doot ------ -------- <br /> Cesspoo|: Distance from nearest well '-'---Distance fn,m foundation - ---'-'--Lining material-- <br /> 171 Size: Diameter ------- ----Depth------'_-_-------.Unwid Copoc��-----_-_.gmb. ` <br /> Privy: Uidunce from nearest wuU�--''----''--'--D�t no: from nearest 6v86�g- Y�' <br /> '_'---''__.-'-'- ,\ <br /> El Distance to nearest lot line--------------------------------------------- .-_.-_''-'---'-'------'--_''____________ <br /> Romo6eing and/or repairing (desc,i6e):_----------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------_______________________________'______'_________ <br /> --''-'--'-'---''--''--'---''--'------'----'--'-------'-----^-'----'--''-----''--'--''-'---'-' <br /> -------'-'---'--'--'--'---'----''---------'-'------'--'---'--'-----------'-- <br /> / hereby certify that I have prepared this application and that fhe work will be done in accordance with San Joaquin County | <br /> ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. � <br /> ) <br /> ;»�nw��. �� .-------------------�Ownw, and/or � <br /> -''''-_.'''--'''-''`-le)-''.- -~-. --------------------- ---- --_' <br /> (Plo+ plan, showing size of lot, location of system in relation to wells, buildings, efc.. can be placed on reverse side). ' <br /> FOR DEPARTMENT USE ONLY <br /> �� ---------------------------------------------- ----------------iA <br /> ---------- <br /> ---------------- ------------------_�������������-------- ------------------------------'----------'---------------------------------------- --------- ------------------------------------------- <br /> -------------------------------------- ____�_�_____'______________________'____________________________________' <br /> .-''-''---''---'_''''-''''-- _-'_-''--''-'''_''''-'''--''''-'''-''''----'---.----''--' <br /> RN/\L INSPECTION BY:.......... -''-''''-''-- Do+e' 7�'. ''-'''--'-''''-----'' <br /> SAN JOAQUDN LOCAL HEALTH DISTRICT <br /> /xo s""m America" Street »*v West Oak Street oz Sycamore Street 8/4 North '�C^ St=* <br /> Stockton, California Loai. o°|a"m/° Manteca, California Tracy. California <br /> E"_,_`m 145446^`°CU" .,". Y <br />