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� ~�� <br /> �, <br /> � <br /> } APPLAPPLICAPPLICATIONFOR SANITATION PERMIT Permit No .�~^.��Z�'.. <br /> k���o�fm 0m Duplicate) <br /> Dufn |ove� <br /> ` ' . ` <br /> Application is hereby made to the Sun Joaquin Local Health District for o penn|f to construct and 'install the work herein described. <br /> This application is made in compliance with County Ordinance N <br /> 9-- - 47 ------------ <br /> - X <br /> Installation will serve: Residence Apartment House El Com-mercial E] Trailer Court Motel Other 0 <br /> ------------------ <br /> Number of living units: -t--- Number of bedrooms -------- Number of baths -------- Lot size <br /> Community system El Private F1 Depth to Water Table -------- ft. <br /> Water Supply: Public system" <br /> Character of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loam E] Clay Loam [] Clay [] Adobe Hardpan E] <br /> Previous Application Made:' Yes 0 No K New Construction: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> D osal Field: Distance from nearest well- ___. ------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> isl�� t <br />~~ �� Number Length <br /> /yPn *l C|h,, material--------------------------. . 'Ovp'h of filter material-� Jo+o| length ' ~�� <br /> ~~ <br /> Seenane Pit: Distance lo nearest well_P1V_WE------Distance from foundation-N#/V1E_.'___.D;stance to nearest lot line-'r"I <br /> number of p/ts�&v.�----------Lining mu' nu.^F".^"^°�--~.",. D.,,.e.=~`~V.^~`,,_Dept,..,=~~ --- <br /> Cesspool: <br /> _Ceu . , : Distance from n«uru, °vL-'---Dbtuncefrom foundation--'-'-� Lining mofe,mL--_-''--�'''- ' <br /> El Size; Diu ' r�-.------------Deofh--'---_---------.Liqui6 Capacity. - --------- --------------gals. <br /> Privy: Didunca:fn,m rearest well -------------------------------------------Distance fncrm nearest building------------------------------------------- <br /> Distance f <br /> .----'_------- <br /> Distancoh, nearest lot line----------------------------- -''_''''------------------------------------------------------------------ �-''_'_''- <br />� <br /> m. 8 <br /> Remodeling and/or repairing (6n��6e):-^��^,w������--__�.e�_-_-^��~*��uc�e�mc-.- -_'...nuz,/c. <br /> -_--_'__.-'-__--'_---'---''---.__--_-'---_''___-''-'''__.--'--''--~---���--'-_.'---''--------' <br />� ------------------------------------------------------ -_-__._- ----------_ ----------------------------------------------------------------------- .--_--_ ---------------------------- , `~ <br /> -------------------------------------------------------------------------------------------------------------------------------- <br /> thatI hereby certify h 6 +ha+ thowo� viU be 6 in accordancewith San County <br />` <br /> (Signed) ' <br /> my�_ -'-' -'---'''—'--'' <br /> �� ��. ��� �� *fl� ��� o� ��m � m�� fo =� E���� �� �� 6e ��o ��o� <br /> FOR DEPARTMENT USE ONLY <br /> / _ ~ <br /> BU|LD|NG PERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE'''-'__.'---'-'-�'�-'__'-- <br /> '' <br /> � -----. ��. \ <br /> '' ~~'^~~^~&��'-'^~^'~-�~-----��- -'--'-'��--`�-- <br /> � - ���'�'-'''--��--''''-''''--'''-'''--''-'---_''-'�'.-' <br /> 0 /J <br /> w ~ ,� <br /> �N/\L INSPECTION 8Y�''''-''8���*������fv��---_. Do+�---��-- ---------._-----. <br /> � <br /> SAJN JOAQUiN LOCAL HEALTH DISTRICT � <br /> 130 south American street 300 West Oak Street /32 Sycamore Street m+ worth "C' Street <br /> St"ckton, California Loj;, California Manteca, California Tracy, California <br /> � <br /> ES-9-2M 10-52 Rev�sed W-2100 <br /> � <br />