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� <br /> APPLICATION FOR SANITATION PERMIT(Complete in Duplicate) <br /> r� ' <br />' n6install thworkherein �6e6 <br /> 10 <br /> '"'^ apr'`a""" is "'"d"/° co^'r'~^'`~ with `^`~^'/ ~'~^'~^~ <br />' <br /> JOBADDRESS AND <br /> ' Phone <br /> -_'_- �_me—_� - - ~- - <br /> |nstallation will Apartment House E] Commercial E] Trailer Court [-] Motel E] Other E] . <br /> � Nu b�r of living units/ � "Number of bedrooms Number of baths '� Lot size-. ------ ___-_' ' <br /> Mz� <br /> Wa+m, Public system [] Community system [] Phvn+e �� <br /> Character wfsoil toadepth mf^3 feet Sand [] Grave| []"^Sondy Loam El Clay Loam El Clay A6o6ng Hardpan E] <br /> y . A <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No <br /> PECIHCAT ONDz/No septic tank n, cesspool permitted if public sewer isavailable within 200 feet.) ` <br /> Septic Tank: �Distance from nearest well-----------------Distance <br /> 'from foundation--------------------Material _---------------.-.- <br /> Nu of compartments--------------------------Capacity-----------------------Si7a------------------------------- Liquid depth-__-____ <br /> i :- Distance from nearest well -'--------Distance from foundation--------------------Lining motvrinL_-'��--'_-.-_--- `w <br /> [] Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: <br /> ___-.-__--._-_-__PMvy, Distance from nearest well '-_----- -----------------------------Dist*nc� from nearest building------------------------__-'-'-- <br /> M Distance to nearest |o+ 4n-_-_--.-__-__-_-.___' <br /> Seepug* Rt: Distance fo nearest voL_--_--_Disfance from foun6mtion----------------Distance +o nearest iotline----------------- <br /> Number <br /> --__.- <br /> �x ` Num6er of pits-----__--'Uning material <br /> a+o�oL----_--.-S�e: Diameter <br /> --___--Dooth--------------------------------- <br /> D <br /> .--_---.--_.--' <br /> Dpo | F|o|6� Distance U � �/ D| cuf,om foun�a+ion. ^ � ..�.D�� nco +ono* ,�+ |vf |inn .2�] � �'-' -..-' <br /> �' Number of linesLength of each |l Width oJ �vnch_- � . .--'_. <br /> Type of fi|+or mafu,iuL ,e- . � .-Depth of �|tw, matnriaL�� _ �_ <br /> Remodeling <br /> - <br /> ~ <br /> n6/or > K <br /> U ---------'-'---'---'---'---------''---^----'------------------'--------------'---'--'-------------'— <br /> , ------------------- <br /> I hereby certify that I have <br /> red this application and that the work will 6* done in accordance with Sam Joaquin County <br /> ordinances. State laws, and rules and' regulations of the San Joaquin Local Health District. <br /> ` <br /> (Plot plans, showing size of lot, location of system mrelation to wells, buildings, etc., must befiled with this app==). . <br /> FOR DEPARTMENT USE ONLY <br /> REVIEWEDBY------------------------------------------- --------- ------------------ ----------------------------------------------- DATE----- f------ - 7------- <br /> Altoratiuwsmn6/v, nacnmmwnda+|onu:------------------------------- ----------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------.-___--'___-.-___.-__----.----.__-__ <br /> ---------------------'�----------------'----------------------''-------------------'---------------'------------------------------''------'--------------'----'----------------------------_�����������- <br /> _--_-___''__-''__.''__.'''__.''__.'--__'''__-''----'''-_.-''-__--'-__.'''----''__.-_.'-__.-'_--- <br /> ___---__-__---_-_. _'-_____-___.-------..__-_----_--..__._- <br /> -�� �� - � ��m� �/� <br /> PERW|T No_�-�.-� ------ ISSUED--��'' __(Dot� FINAL INSPECTION BY�-`,-� ��----------------------------------------- <br /> Date <br /> '_- <br /> . <br /> . Dofe-------------------- -'---'------ <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> � <br /> Stockton, California <br /> ' <br /> ES-9-2M (1-50 w-1639 <br />