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' � ' APPLICATION FOR SANITATION PERMIT Permit N. . '_� . ` p~omp�t� /� Duplicate) ` ' ~~ Applicafjo' Dofo |o��6 � �e�6v made to the �m + ----'--' T�� o��of�" � .,6* � co�p|�ncewith County'�Ordinance No. 549. �o�qum �oc� Mam�6D�f�ct �ropunn� +oconsfmctun6 ��aUthework6e,e|n6esc,i6ed. JOB ADDRESS AND LOCATION -------------- � ^-Ow��J��nvOwner's�-Nu.m..e._.- -----------------.'~-`''--^-. °-''--'�-'-' '-'----''--'-`--_-` -'- -_`-_' --_--� Address.....----------- '''--------------------------------------------------------------------------------------------------------------------------- -._-'- ----------- P--�h_-on'_--- e-__-.________ ___._�___________-- --'-- ' � _--'' _---''___--_-_. '_'_'_ '_-_-__' _.-__'-_--__ ' �_-'''_�_---' _ - - �- ' '_ Conf�cforo Name- ------------------------------------------------------------------------------- Installation - - `' ~ ^/ � | ' � �st�«+�n wU serve: ---_--'-------''''--'''--'''-�--'-----''-- Phone' -'-------'-'~nnon �� Apartment House 0 �ommor�u| [I Trailer Court [] Motel 0 Of6*' []N«m6*rqf |ivi»g units: -------- Number n[bedrooms --' 'um6n, of 6ofhi '� Lo+ sizeWmto' 3uo�v Public system EjCommun�ysystem [ ' '' =+a 0 DepthfoWafer Tu6�^--'' ft -'-- -'-- Cha'a*+*rufsoU +oadepth 3fow+: Sand EGm'e| [ an6yLoum U Clay Loam 0 Clay E3 Adobe El HardpanPrevious �6a, ye, El No 0 Now Construction: Yes � N» ' FHA/VA: Yes No E]TYPE OF INSTALLATION —D S - '��`''=~"` (No septic tank mr'cnsspoo/ pe'nHfe6 if Public sewer & available within 200 feet.) Sept Distance from neuny,f well -----�Distance �u fuun6ufiNo. vfcompartments---' ----S�e On-'-----''`.Mufe,iuL------- --------- Liquid 6oPf --------Copu�`----------------------- Disposal F��: Distance from nomrou weU-'--�-D�f Distance from f» 6u " Number of |�m� ----, -Di�ancn to »u�re`+ lot |�e--------'' Length of each line------ Type Of filter mof*r�| -''--'''--''�W�+^ cJfnench , � ---Uopf6 of fi|fur material '--'''--Jof / �nof '-'-' ----------------------------- Number ---' -S»ep*g* pit Distance to neu,e �eU_______Distance-from foundation � ----'-'- ' Numbor of p�c___-_��__�n�g-material-----------------------S/o': u/um»t«''- nceto nearest lot 8n ----------------- ------------------- Deo+ '----------- Cesspool: Db6onuy rn�m nun,�t well D��»oe from foundation�n '-''- -Lining mufo�*LS�o/ Diameter Depth' --''''-----'--'----Uo�d C*puc''' -g«�Pr�«: Distance 6nnm n°or�'t well ----------------- Distance --'-'- D�funo, +o nearest lot |�c�___ _ _ _ ` Distance from nearest building �__.'---- -'''- ''''-''-''-''---'-''--8*m"6oing and/or repairing (describe):--------------- ----------------------- _ __ ----''--'--'---------'----''---'---'----''--__.^_____ --------------------------------------------------- r--'------''-�-i_-______ __''--.-__----------__- --'_----_ _.. --_-''---- .. ��' '----' _______�_ _-r ____.__________ -'--_-'-_---'__ --� '`------'-'vrd�ancev' ~'~'= l~~~' and rules and regulations of the San Joaquin Local Health District. v6mn«nw�6DanJwao��n Cnunty/ h ' -- ' havwr the *o'^ will be 6000 � *�� --' (S�ne6) ___.. �.��_��_��_'`.�,._ _-,__`____,_---------- ------ '' _.___. --'''---''----'^--=-'--�OwnmranJ/o, '---'---'---' --------------------------------------- -/ ' --/P�f plan. -_. , s�e of �t /ouanum o� system in --'--'--'"eonhn wo/�. 6u36�g� o+c~ man be placed APPLICATION ACCE'/Eu BY' -- - and/orrecommendations: � � -- DATE-------__.---------- --__--'_--__-' . ._ -----__--_-�-'--'_-''_- _ -_--_'-_-' '-'''-_'_ -_---__''� - - -- - __-__._---'_ ''- '-- �_ - - ' -'-_ ,' -_ . - . . .-_- -- - _ . - ' -------------------------------- ----------------------- _ ._ - _-- - ---- - - . '- .- ' -- '- -'. . . - -''-'�'- RNAL USPEIT }N' QY: �--'''-''--' '---- uvhe 130 South ' ~~ s�e� SAN LOCAL HEALTH DISTRICT 300 Oak y�=t /azsv" m"m �=o Stockton, California' Lodi, California w,"m"", c�x�m� 814 North "C" Street ES-9-2M «°,isov 1.57 F.Pcu Tracy. California . ^