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FOR OFFICE 7E- 14" <br /> a SANITATION P <br /> - APPLICATION FOR ERMIT <br /> Permit No <br /> (Complete in "mp"cmrw) Date |sswmJ <br /> Apo||cmMo" is 6wre6v made to the Sm" Joaquin Local_Health District for <br /> u permit to construct and install the work herein described. <br /> TLix application is made in compliance with County Ordinance No. 549. <br /> �� <br /> JOB ADDRESS AND UOCAJ|�]N---.�����--..-��'=--��.*�v�m�m�^��--x~�,�^�xu�-----.-----.-.--_''-'---------' <br /> Phbne. <br /> Installation will serve: Residence 2"Apartn-rent House E] Commercial 0 Trailer Court 0 Motel [] Other 0 <br /> Number of living units: Number of bedrooms Number of baths _27:: Lot size ---71�7---A---- .......I--------- <br /> / Watwr Supply: Public system Community system [I rn~*.e 0 ""p". ." Water Table ........ ft. <br /> ~_ <br /> Character of uoi| to a depth of 3 fmaf Sand [] Gravel [] Sandy Loam [] Clay Loom E]- Clay [] Adobe Vff- Hardpan 0 <br /> Pmm*;mvs Application Made: (if yes,date---------- - ' ----) No L2,' New onstruvtion� Yes No lar" pHA/VA. Yes [] Np [Er <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No <br /> mm��� tank or ceuapwm| permitted ifU <br /> �� public sewer is mvuUo�evWt�6n 200 feet.). �-' <br /> ' a from fou_ndo_�o_n--'-_'_-Mu*mriuL-----.---...- <br /> Soptic Tank: Distance from noun,s+ woU---.--.D|�anc _Liquid depth-'_-----.Cupadty__-- <br /> CN�� ~ compartments '_---_-..3�o__-_-.--------- <br /> Disposal <br /> -_ <br /> u ^ u��ncn ,n,m """"=, °=., "� ~ ~.,.,.,~ from foundation-_10.* Distancenearestlot | -�--7--^.--- <br /> ~ <br /> of lines <br /> Length of each line--- <br /> ~~ � Type of filter material., materi*L. <br /> ' <br /> % <br /> D o��nco �o nouroa+ �| �� � �� Di�u oo f m 6zun�uMon.-�� � ' ueure�� or <br /> line <br /> S~` p. ��~ <br /> um6orofp�o_ �---..Un|ng mofer�| -S�o� n;nm�nc..- ~.- <br /> -.- <br /> � -- 'w�°--, 'Distance from nearest <br /> weU ----.-D�tanoyfn�m foundation' mu�or�-'-'-'---'---_' <br /> `^e"^r~~^ � <br /> --. —. | <br /> city. ' <br /> --------------gals. <br /> [] Size: D�matoc.— _—.----.—D of ..�----------------1; Uqu�6 Cupu`. .,,' Distance from noon°� wpU---''--''-''_'---'Di�o co from �m�� 6mUJ�g-----__-__---- <br /> Distance to nearest lot |�o—,''-''-'''-'''-''�-_'-__� . _-_____�_.______ <br /> I � r ^ <br /> Remodeling and/or (describe): --' � _.-_-._--__--'__. <br /> -----''-----''-`'--=--'--'---'------'--'---- <br /> -''-�-------'-�'''-- -'----_-----'---- <br /> .--.—_---._..-x .-_-------�----------------'-----------^ <br /> ----'''--''--''--'--'-''-'-'--'-- <br /> ` . -_.---.'--''-'-----' <br /> _ �_-'----_-'-'' <br /> I hereby certify that I have prepared this applic;t;Zn 'and that the work will 6� din—e in_icc_o;da_nc­e with San Joaquin County <br /> ordinances, State laws, and rules and 'regulations of the San Joaquin Local Health District. <br /> B�_.._.._.����m~�-- �==- ------------------ ------ `6 '| --�- � �6�� <br /> /�� plan. ��\ng �� � location � � ��� � we�, buildings, ��c� m� pon ��� ' <br /> ` <br /> FOR DEPA TMENr USE ONLY <br /> APPLICATION��ACCE�PTED BY----...... ------ -- --—-------- ----------------- ------ DAT <br /> AfteratlionZs or recommendations:------- <br /> - ' -|NSPE�T Do�� /� �/^ ------------------------------------- <br /> RN�L �]N QY� _�____ ___' __ <br /> � '— <br /> LOCAL HEALTH DISTRICT <br /> 130 South American Street 3ppWest Oak o=°° v2oSycamore Street ovmWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> cx p ncwsco e':9 uw n'uz ^/u^s <br />