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� <br /> � <br /> APPLICATION FOR SANITATION PERMIT Permit No.o.. ............. <br /> k��mm�fe �n �uwOca�� / ~~ <br /> (Complete Duplicate) Date bsma] '-- � <br /> /\ p|�af�n is hereby mo6n to the San Joaquin Local Health District for o permit to construct and install the~o� herein described,T6|oopp|ication is made in compliance with County Ordinance No. 549. <br /> " JOB ADDRESS /\N <br /> Owner's m z-- Af k <br /> -------- Phona-?)_e)-r�-- --- <br /> ?�, ----------------------------------------------------------- -''--'—'--- <br /> ------- <br /> Contractor's Name--------- -- l <br /> � '--''-.'_- Phonu--''-'---'--'- l <br /> |msta|lation will serve; Residence M� Apartment House F7 Commercial 0 Trailer C� ' � Motel E3 Other L3 <br /> Number of living V. <br /> ' Number of bedrooms 9 Number of baths --- Lot size -574.X-��.10,0-------.. <br /> ' <br /> Water Supply: Pu6|lu system Community system E] Private E] Depth foWater Table ,-/A ft. �. ' <br /> Ckomcfor of soil to n depth uf' feet: Sand E] Gravel El Sandy Loam E] Clay Loom [] Clay [l Adobe [] Hardpan El <br /> Previous Application Made: Yes E] No $r New Construction: Yes [] Nog <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> /No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> Distance from nou,asf weU-----,Distance from fovn6afion-------MufvrjmL--------'------- <br /> 44p� No. ofcompur+menis-__- --------------- Size----------------------------- -Liqui6 6ep|6--------------------------Capacity-------- ---.-' <br /> Disposal Field: Distance from nearest K. _Distance from <br /> foun6ofion-3_j5�--�--.-Dint*nce +onearest |o+ |-i=n-e- _ <br /> -------------- <br /> Number '� <br /> ul lines .. r Length of each line . - ...... <br /> --.-Width oftn,nch-` p.� <br /> Type of filter ma+e�ai.1��/?0 �.-Dop+ of fi|h,r moh,huL-i�'---Tof | <br /> length ���/ <br /> Seepage Pit: Distance to nearest well_92-0-A­Q�-----Distance from foundafion----'3..47�.---.Disfance to nearest lot line--- <br /> -------------------------------------- <br /> nr6�an�oo herebyState laws,' and m��t I have 'mm' reg^��~~red this application <br /> of �he ��n Joaquin��Lm�a Healthe work will ' done in District. accordance-- - with -- Joaquin- - County, <br /> (Signed)---- '''---''''- <br /> ' ' x�. � �----- �—'-----''---''''`--'---�----'''''----- �-'--' <br /> �� ��. �� � |� ��� of stem in relation to wells, buildings, etc., can be placed on reverse side)._ <br /> FOR DEPARTMENT USE ONLY <br /> ` <br /> � /\PPL|CAT!DNACCEPTED -_------._-.-.--.-'_-__.-._' <br /> � <br /> RGV|EWED 0Y.'''--.--.'''- ?}-''''----'----_-''-'-''--'''_-'' <br /> ' <br /> BUILDING PERMIT ISSUED------------ <br /> DATE-.-«�� <br /> � /�|fn'utionoand/or recommendations---------___________.___-_________._____-`mr-------------------------------------------------_ __ ___. <br /> , <br /> ` ----'''_-''---'''_-''---''''------''---''''-'''--'---''----''__-^'-''''--''-'-'''-___--.--'._---.__- <br /> . --- ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -'_------------ ------------- ------------------------------------ ''''-'_-''--'''_--''-''''-''�-------------------------------------------------------------------------- <br /> � <br /> ! ---------------------------------- ----- -'---------- ''''--''--'-' -------------------- ------------------------------------------------ <br /> | FIN/\L INSPECTION BY:--------------------- ---------- Dotu-----'_.-------------__.--.� <br /> ' SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> /30 south America" Street 300 West Oak Street mz Sycamore Street 814 North "C" Street <br /> Stockton, c"Hforn;a Lod,, California Manteca, California nmc» California <br /> � <br /> ES-9-2M m',u n",/.°a W-x/oo <br />