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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued J. <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 wifh Counly inance N-t. 549, <br /> JOB ADDRESS AVb C I N-------- ji- `t`, 4�4�_ i jo�------------------------------__--------------- ---- --- <br /> Installation will serve: esidence 5(Apartment House [:] Commercial E] Trailer Court El Molel 0 Other <br /> oms _Z__ Number of baths J--- Lot size <br /> Number of livinq units: umber of bedro <br /> Water Supply: Public . ��Communify system El Private E] Depth to Water Table -------- f f. <br /> Character of soil to a depth of 3 feet: S d Gravel E] Sandy Loam Clay Loam [_1 Clay [:] Adobe M/Hardpan <br /> Previous Application Made:. Yes Ej No �eNew Construction-: Yes W;N� o 1-1 <br /> � <br /> (No septic tank p` cesspool permitted if public sewer is availabl- --' -- --` ' <br /> X foue, o =". �nk: D�fu f well ----------------- <br /> Sep" <br /> Y <br /> P,,� <br /> D� Re|6: Distance from s+ : - u �u �o ,uunonno ."a.`s. . <br /> " orr:= . ------------------ <br /> Depth <br /> Number of ||n of each xno_-. m _ <br /> of of filter mafv�vL--A��--�nt°| length---.K.^- - ---------------------- <br /> Type of filter mat <br /> Seepage Pit: Dl�tono, to nearest well----------------------Distance from foundation------------------ Distano, to nearest lot line----------------- <br /> El Number of pits '-''-- ----Lining material----------------------- Diamefer------------------------Depth-_'_--'--'-'- <br /> Ceupoo|'.� Distance from nearestwell Distance from foundation Lining material- � <br /> EDiameter <br /> `. <br /> S�n� U�om�+er_��---,_--�_.Duo+ -_����__---------_Uqvid Capacity----------------------------gals. . <br /> Privy; Distance from neor=sf well-,---'_��---'''__����''Distance from nearest buJding------------------------------------------- <br /> Distance to <br /> ��'`-''__-_-'-��-Didancnfo nearest |nf line----_----------------'-----------'----------------_--' K <br /> ° <br /> 'Rrmodel|ng and/or repairing (closcr�6v :_---- --_-.----___-__._--___-.__-__._--__-'-_-'-________- <br /> '-____..-_----_'-__-�_.----_�----_''_----_.---_--'-__''---_-'__----'--'-''_-.'- ----------------------------- <br /> ------------------------------ <br /> -__--__._---. <br /> ._--.__---___.__-_--__,____..__._-.__----____.___--___--._---_''__.-_.''�_.'''-'--' <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that | have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulafions of the San Joaquin Local Health District.) <br /> (Signed)-- ------------ -------r - / <br /> and/or Contractor) <br /> ----------0_9Z---- , <br /> . * <br /> BY:-....'.�-------?w-'''---------------'----'���----'-----'�------v'""/'-----'-------------------' | <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be pl.1 aced�on reverse side). <br /> � FOR-DEPARTMENT USE ONLY <br /> o*/E ^ <br /> APPLICATION ACCEPTED BT <br /> BUILDINGPERMIT ISSUED-------- -�_ _N------------------------------------------------- -------------------- DATE------------%011!------------------------------------------ <br /> --'--'--'-----------'�--'---- ' ---' ---------------------'-----------------'' \ <br /> �, <br /> FINAL INSPECTION 8Y�.-vj <br /> -��. - . ----_'. Da+e--- ���_ . -'��---�p-'--.. <br /> ' <br /> SAN JOAQ0NLOCAL HEALTH DISTRICT ` <br />' 130 South American $free+ mmv =+ o"^ Street /oz Sycamore s*owt m* w"*h 'z ' $tr°°. <br /> Manteca. California Tw"v Can4omia <br /> Stockton, California Lod1l, o"kfornia <br /> | <br />. . <br /> ES-9-2w B-51 x*,a*d w/-2100 � <br />. �__= <br />