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. .\ <br /> - APPLICATION FOR SANITATION PERMIT '7 �� <br /> (Complete in Duplicate) °- <br /> � <br /> 6en*6v made to the Son Joaquin Local Hao|t6 Di�� � � <br /> ct � o permit to install the workherein 6o,described. <br /> This application ' <br /> �y�r^-'�|�/xurxm-� -n ismu�� in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------ 9)-j-4—0tj --------ooe��__ -------------------------------------------------------------- <br /> ? --- Phone__.__,;)Z <br /> Installation will serve: parfmenf House El Commerc�al E] Trailer Court El Motel E] Other E] <br />� of livin =� Lot ,�e,���� <br />' ' - - <br /> Water Supply: Public system ElCommun�yuy�nm E! Phvn+eCharacter of soil to a �0� <br />� ' ' ' depth of feet: Sand [] Gravel El Sandy <br /> - Loam [l [1oy Loom0 Clay [l Hardpan [] ` <br />` / ,rE OF """."LLA"=` AND SPECIFICATIONS:. - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-,;-5-_-Distance from founclation-6-41.09PtMaterial----- -- ----- - ---------- <br /> �'''--- <br /> of � � . ~ ~~'---'v <br /> �-�-------------- Lining mofeduL-_'--'---_-__.- <br /> Cespoo : Distance 6nmneoray. °vU-----------------Distance 6nm fuun�n�n " <br /> ^ <br /> Size: Diameter--------------------------------------Depth'_�_-'''---�'''~I---- ---' <br /> ------- <br /> Distance �m nearest well D�� ---- <br /> -Privy: <br /> - <br /> �r�y <br /> Distance to nearest lot U <br /> ------------------ <br /> from fou' <br /> n�o�on.__---__Dl�onoa fu nou,�, lot |ine.__._ <br /> �oepogo Pit: Distance to nearest weU__..___.--Distance <br /> Number of pifs------------- Lining material Size: Diameter------------------------Depth---------------- _._-_- <br /> | <br /> Disposal Field: Distance from neare f �L��-D c�� �o n�u� - Dista <br /> - <br /> \ bf |i Agth of eachZ` �''- �� .. <br /> Rem�deling and/ repaking (descri kvc ----V1 6--------&_ks:fi�_k---------- -W---aE- <br /> XT d 4 X- 1, P <br /> AL <br /> - <br /> /. Wv <br /> | / ^ that \ have prepaapplication and that the work will be done in red ' accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. <br /> '-m�--, -----------(Title) <br /> " By-__------------------------------------ <br /> Uqut . of lot, location of system in relation to wells, buildings. oto~ must be filed with this <br /> R DEPARTMENT USE ONNLYT <br /> | , ` - -------- <br /> REVIEWED <br /> / PPUC�TON �C��p|�u u --� � DATE----------- <br /> ^ <br /> �� <br /> _ <br /> REV|EVED BY--------.--_.-------- � - ------'--- D/�E-' �"- ------------'--''��m <br /> BU|LD|NG PERMIT |SSUED-_---_--------__-.--_--.---------_--.-_-. DATE---------- .-------------------------------------------------- <br /> Alterations and/or <br /> _---_______.___.____._Alte,atimnoao6/or recommendations:----------------------------------------- ------------------------------------------------------------:------------------------------------------------------- <br /> > ------------------------------------------------------ ''--''---------'---------''---'---''--------'-----'--''--------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------'------'-----------'---------------------------'����-----------'----'�����������������������������������----------------------------------'--- <br /> ---------------���������`���`���``��'`�����`�����``���``����'`����```��``����``����������``��'��'��` <br /> � ~� ` <br /> PERMIT No ''- ISSUED'-� -'''�Do+e RN/\L INSPECTION BY�^��L.c^�_~57 <br /> �-__''--_-__-____ <br /> Date-------------~�^�r����-��~--------------------------'-' <br /> SANJOAQUiNLOCALHEALTH0STRK3 <br /> . <br /> 130 South American Street <br /> Stockton, California <br /> ss-9-2M v'nn w//mv <br />