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PLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> T&plicaf ion is hereby made to the San Joaquin Local Health D�stricf for a permit to construct and install the work herein described. <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND L9CATION------ 0-------W-------2-4--)4(-/-o-�- -----/--<-; - --ff:--------------------------------------- <br /> ------- <br /> Address_- -ci-- <br /> Installation will serve. Residence E] Apartment House 1� Commercial PEr"rrailer Court 0 Mofel El Other El <br /> Number of living units: F-1 Number of bedrooms Fj Number of baths F-1 Lot size----L^�^ .--�� '-��-��--»�------------ <br /> Water Supply: Public system 0 Community system [-] Private P--* <br /> Character mfsoil foa depth nf3 feet- Sand E] Gravel E] Sandy Loam F] Clay Loam El Clay El Adubnrl~-Ho,dpon <br /> TYPt OF INSTALLATION AND SPECIFICATIONS: <br />_^ (Nn septic tank o,cesspoo| permitted R public sewer }savailable within 200 feet.) <br /> Sep <br /> D|v+onc� frpm n;orvo+ .n|����m�»-Diufunca from foundation---_--.--��a+v,ioL--------------_-.---- <br /> No. ofcompo�menfs---_-------Capacity-_---_----3�e-'_---_--------Liquid depth-------------------------- <br /> Coo p��� Distance from nearest well-----------------Distance 6om foundation--------------------Lining moto6uL_-.-_'_-_-- <br /> E] Size: Diameter--------------------------------------Dept h---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ' <br /> VL� <br /> Distance to nearest |o+~line___�.-/-*__-_-_-_--_ <br /> Seep e.Pi - Distance to nearest <br /> w�| /� .. 4 ---------------------- <br /> 7 <br /> otpi+,--- Lining moh, � S��� Oivmo+rc'� �- .--Depth-. -__^.-. <br /> .Ii, f || [P <br /> Leng <br /> mber of lines--Am <br /> po of filter mot�,ial of �f . <br /> ' <br /> ^ <br /> � <br /> | <br /> /,11'Remodeling and/or repairing (describe):------------ _ <br /> .____-._-__-___.--__-____-.__-____._---__--__--_-__-_____-._----__-_____--___- <br /> _________-____''__'_______'_____________''___'_-___________'__'''__''______________ <br /> ---------`-----`------`---------``---------`------'---------````���---```��������---`-------```---------````--------------`����''����-------''----------------------------` <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws. a d ru and reqmlafions of the San Joaquin Local Health Disirief. <br /> (Signed)------;;e� :---- ----- ----------------------------------------------------------------- ------jp&am and/or Co ractorr) <br /> ~ - <br /> (Plot plans, showing size of lot, locati n of systen n relation to wells, 6uildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> _____ _ PERMIT ISSUED ___________'___'__________�___________ DATE'___'_____________-_ <br /> Altora+iono and/or recommendations:--___-�----------_----_----_----_____-___________.__.___�___ <br /> � . <br /> -_'__.-_''_-'_-'__.''''''-_-'-_--''__-.''''-_--__-''--_-_''''-__--'''__.'''---__.'--_.'_-'__.- ' <br /> ------------'--------------'------------------------''---------'-----------------------------------'------'����--------''------------------------------------------------------------_�----------------------------' <br /> � <br /> --__'-___'-__.'-_''''''___-''-__''___---''__-'''----'--_--'''--___.---__--------.__.__�-_ <br /> --'--'--''--''''--'--''''----'''''--''''---''----'- <br /> PERMIT No-�» ���� - |SSUED- ///1--G..- �-. 7 -(Da»e) RN/\L INSPECTION _.. <br /> D°te-------- -------A,�_____ <br />� <br /> SAN J[)AQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> ' <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br /> � <br />