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APPLICATION FOR SANITATION PERMIT No. �� <br /> (Cnmp|ofu in Duplicate) Do+o |,,uo6 <br /> Vcz/s__�--^ <br /> _ - <br /> Application is hereby mu6o to the Con Joaquin Local Heo|H` District for u permit to construct and install the work herein described. <br /> This application is made in compliance with County {>v6inonco No. 549. <br /> �~ J{}8 ADDRESS AND LOCATION.A.- J\ _- 7F*�t._»�.-�� .qj_ <br /> " � ��� �� <br /> C)*nor', Name---------'_.-^����u����—'��.��r����3^�r,e��—� ---------------- nne....~=—V7.9 414#Z <br /> A6 �� �� ' �� '' Zoe'---------------'--------------'' <br /> Contractor's Nome--._---_-- — ----------------------------- Phonv—_:?�-k- ��q7-------- <br /> Installation will serve; Residence E] Apartment House El Commercial e Tmilev Court E] Motel [] Other E] <br /> -- <br /> Number cfliving unit,: — /�� Number ofbedrooms —�J�Number of baths Lot size ..���������—.���.x�..���-��- <br /> Water Supply; Public system Ej Community system X Private F] Depth to Wafer Table -0-Oft.-7f- <br /> Character of soil to u depth of feet: Sand [] Gravel E] Sandy Loam [X Clay Loam [] Clay El Adobe El Hardpan El <br /> Previous Application Made: Ye, E] No [g New Construction: Yes [] No E] <br /> TYPE C)FINSTALLATION AND SPECIFICATIONS: v « <br /> _. (Nn septic tank or cesspool permitted if public sewer i, available within 200 feet.) <br /> Septic TarLk: Distance from nearest well-------- --------Distance from foundation--------------------Material ----------.-----' <br /> AK |�JjmJ[L No. of comportmen+s------- ------------------Size--------------------------------Liquid 6ep+k--------.-Cupucity----- ---------� <br /> �~ Di,pcuo| o|6: Distance �o well Distance from foundation Distance to nearest lot / <br /> Nlumber oi` | Length of eachx Width of trench. <br /> ------ <br /> Type of filter material-- ..---Depth of filter material /oru/ length------------------------- <br /> `~ Seopogo Pit: Distance to nearest ~oiZ-00.' — Distanceto nearest lo onv'! --- � <br /> Number of pits--- �--.---�ning mate�a| —.S�e: D�mete, �����°'—Deot �����—� ��_`---' <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_'—'___---- ~^ <br /> �~ [] Size: Diamvtec'_''_'--'--''_ ----------------------------------------------------Liquid Capacity----------------------------go|s <br /> Privy: Distance from ooums well._--''''------'—''Dbtonce from nearest building--''-''----'_---� �k <br /> F-] Distance to nearest lot line------------------------------------------------ ----_.----_---_---____._________ ^ ' <br /> Kvmo6e|ing and/or repairing (describe):-----_—_—__'__-_----_-_------.__—__-------_______________ <br /> ------'-------'-----------------'------'----'-----------'------------'-----------------' <br /> ----_'—_-_--'_- ---------------------------------------------------------- <br /> ----'—_---_'---_' -----_--_-_____._—_--__--- <br /> I hereby certify that I <br /> hrepa,oJt�, application and that the wo, *U be done in accordance with San Joaquin Countyvn6inances. Pof the San Joaquin Local Health District. <br /> -_ (Plotplan,_ —showing. size of lot, location of system <br /> IF <br /> FOR 1151EPARTMENT USE ONLY <br /> -- and/or <br /> --------------------------- ------------------------------------------------------------------------------------------------------------------------ ----_------'------------------------__--- <br /> ---------------'-----'--------'---------'---'------'---'----'------------------ <br /> ---'------------------'-------------'—'-----'-------------'-------------'—'---- <br /> ----'—'-----'---'----------------------------'-----------------'--'----''—'------- <br /> F|N/\L INSPECTION BY:----- Z--------' uune-- --'----.-.----_-------------_--- <br /> SAN JDAQU|N LOCAL HEALTH DISTRICT <br /> /m South American Street 3ooWest Oak Street /o Sycamore x*"°t xw North ^C,' Street <br /> -- <br /> Stockton, California Lodi, California Manteca, California Tracy, California ^ <br />