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- <br /> ^�7 ~ <br /> FOR OF� �. <br /> /`�=+`^~~ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> - � ' yn ` <br /> - ---'-------' - r~~'p�'~ �~r^~~'~, ^ Bmfe Issued / ^ <br /> Application is hereby made to the San Joaquin Local Health Dist rict for a permit to.construct and install the work herein described. <br /> This application is made in compliance with Cbunty Ordinance'No. 549. <br /> JOB ADDRESS AND OCAT N.04 <br /> --------------------------------- <br /> |nstallatiom will.ser�e: Residenceg3-`Apartment House El Commercial E] Trailer Court [] Motel [] Other 0 <br /> Number of living units: /- Number ofbedrooms �»' Number o; baths Z- Lot size ''--'-----' <br /> Water Supply: Public system nity system [] Private [] Depth TO WaterTable�� ft <br /> Character of soil to w depth n�� f��f� SandE] (�mvm| [� Sandy Loam [] Clay Loum [] ��uy �l /��6���~Ha,6pmn [] � <br /> '- -' ~~ ^~ | <br /> Previous Application Made: Ufyes,date--------------------> No 9?"'-New Construction: Yes Pt~~No [] FHA/VA. Yes R~~ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS., <br /> (No septic tank or cesspool permitted if public sewer is mvmOm6|e within 200 feet.) � <br /> Septic Tank- Distance from nooras+ -����-.D f oo-..^��--��� ^��~�� .................. <br /> No. ofcompur+mmn!s-~- ---- ----------- <br /> Size_������-XCO'�Uqu|6 depth------j;r^ _� -----Capacity_����N�P...... <br /> Di,p�o},~o-| Field: Distance from ~ from foundation.. ~ �« � D| t | |i <br /> ��-^ <br /> Number of lines --z +6 of -�- <br /> - <br /> each line- � . V <br /> Type of filter mote,iu|ZDepfh of G|hvr muto,iuL. � ��--]otu| length-'Za;f:7,-P. ---------- <br /> Seepage <br /> Pit: Dist*ncm to Distanceto nearest' lot ' <br /> Number ofpits---.��--.—Lining Size: Diame+or_,����-� --------Depth"�1-w-1---------------------- ' <br /> Cesspool: Distance from nearest well ----_Distance from foundoMon�—_-'—Lining material .''----'---._-- � <br /> [] Size: Diameter--------------------------------------Dept ---------------------------------------------------Liquid Capacity----------------------------gals. ! <br /> Privy: Distance from nearest well '-''--'''--.''�----------- Disfunoo from nearest building''---'''_-_--'--- � <br /> 0 Distance to nearest lot line - _ ___---._------' <br /> Rnmn6eling an6/or,apoiring (describe):................. -- ------ 4��--------------------------------------- � <br /> ---'-----------------'-------'--'-----------------'---''------'--'---'------'------ <br /> ...........------------------------------------------------- -------------------------- ----------------------------------------------------------------------------------------------------- _'---'----------- <br /> '---.....' ------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------- <br /> | hereby certify that U have prepared this application and that the work will be 6nme in accordance with San Joaquin County <br /> ordinances. State laws. and rules and regulations of the Sun Joaquin Local Hem|H6 District. ` <br /> (Signed) -_-.- ��' ------------------------------------------------- or Contractor) <br /> By.---------------------------------------------------------- ----------------- --_-----'--- Y <br /> <P�f pkmn, showing size of lot, locationof re�+�m to w�� 6uU6�n�� otw, can 6� �a*m� �n rw*�rwo ��e� / <br /> ^~ . <br /> FOR uErAn/nwEN/ USE ONLY ' <br /> _ ^ - / --_ <br /> REVIEWED BY-_---_-_-'-------------- ---.--.--_-------. DATE---.------.----_-.-_---. <br /> 8U|LDiNE� PERMIT ISSUED -- DATE� <br /> ------------- _A14_1 'e;,Ztf---------- <br /> ----- --------------------------------------------------- ...... --- --------------------------------------- -------------L..------------------------ ------- <br /> ------------------- <br /> FyNAL INSPECTION 8Y:----- D .-'* ---- <br /> ----.. <br /> SAN ---. <br /> J����U|N L���LH���H �BT��� <br /> 1vpSouth American Street xnvWest Oak Street `s*Sycamore Street m0uWest 9th Street <br /> mmakl.n'c"nv="/m | <br /> ' -~ -- / '^ ' | <br />