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>~� APPLICATION FOR SANITATION PERMIT Permit No. � �umkuu+m (Complete- Duplicate) Date Issued -This Permit Expires 1 Year From Date Issued ��x[,!��z� " � ��vm�a � �a �nJ�quin ��| H�Hh D�66�rmpermit �mnmm� o� in,�|l �e�� herein described. T�i, application ismude incompliance with County Ordinance No. 549 -- ADDRESS �- ��p� �� � ' - '----------------'r--'-------^----'-----'----' Owner's -----.. Phone- Address ,qn*. A66moo-__. '------ -' -� - - ------_--.-----.-- -�'____. Contrac+or'sNamo--_ � -------------------------------------------------------------- --'-_--. Phone- .....................-------- Installation will -'|nstallation "ill serve, Residence Apartment House 0 Commercial 0 Trailer Court [] Motel L] O+6e5r Number nfliving units: ^� - Number ofbedrooms�? Number ofbaths .~ . Lot size ......'a�0./--- -v -' Water Supply. `Public system N Community system [] Private E] Depth to Water Table .yr� Character of omU to a 6eo+6 of 3 feet: Sand E] Gravel [] Sandy Loam [] Clay Loam [] Clay [] A6o6e6K Hardpan [] Previous Application Made: Yes El No N' New Construction: YosX No E] FHA/VA. Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank �r ��s�p�*| permitted |f �u�|lcoawe, Yo a°aY|o6|m �lfk|n 20� feet.) . 3ep+ic.Tank: Distance from nearest ve|| i,tonco from 6o nclution A) ^~ W.atoi | 19 No. ofcompartments----��---.Si�o-��N��N��.---.Liqvid 6epth--.��'�----Copucify-1��'/z�y�f�K` � ,� Disposal Field: Distance from neuros+ woU' i,t*nco from foun6utinn'/P-------Distance +onearest lot line---- Number TI? � - Typo of filter ,nu+erio|�^ --.Dvp. filter r mo+v ' length--..�<�.��'~------.. �~~ ~ '~ Seepage H+� Distance to neun,� well- Distance irom foundu+�n..'.��' ! '--D�+oncr to n;mn°� lot |im�- ]�' ~~ Number ofpits--------2------------Lining mu+o,ioL:7 Size: Diome+vc.. r~--..Deof ------------ �m Cesspool- Distance from nearest well --'---Distance from foundation--------------------Lining mo+ohuL_''-'''-'----- F1 Size: Diameter'--------------------------------Depth----------------------------- ----------------------Liquid Capacity---------------------- ----gals. Privy: Distance from nearest well �'-''''-''�--''-----------Disfanry from nearest 6m�6�g_'-_--'-'__-��-'' �+ [� Di��noa +onown,� |o+ |ino---------_-.-----_---_.__-_--'-_---._---------- � Remodelingand/or repairing (]ascribe):-------------------------------------------------------------------------------------------------- ------------------------------------------------------ -------------------------------------------------------------------------------------------------------------- --'----------------------'--'----' ---'-_-'-''-_.'''�-''-_.''_-_---'-'___'''--''--'--''-----_''-_--__-'-','-''----'--'--��-''-'' ----__-�--__---.--._-.__.-__.-----_----_-_--_-__---_---._-_--__._---------- | hereby certify that | have prepared this application and that the work will be done in accotdance with San Joaquin County / ordinances, State*11aws, anda�ules jo�!nddreg�ullafions of the San Joa�quinLo Health District. (Plot plan. showing size of [of. location of system in relation to wells, buildings, etc., can be placed on reverse side). FCI�DEPARTMENT USE ONLY Altw,mtivns and/or recommendations:------------------------:------------------ - ------------------------------_----_-----__,-- -------- --' ---- '-' ---------------------------------------------------------- '' '---` '-��/^ --�'- ----'-'''--''--'''---'—'''---'--^' -----'_---------'-----_--_----_--.__---_.--_�--.___-_-_---------------------- ------------------------- ---------- _'---'----'-''-''--' ----------- -'''--''-''''-''''--''''''--''--'-''-'''-''-'--'-'-'�-- � F|N/\L INSPECTION BY� '''--'��'_ Oo+�'��.� --------------------------------------- SAN ''-''-''---'-'' . . ^ * � SAN JOAQU|N LOCAL HEALTH DISTRICT /oo n""m American Street uom West Oak Sfreat /uu Sycamore Street ow North 'C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M x.,',eao''�p ~p.c".