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-'~^ x <br /> ^° APPLICATION FOR SANITATION PERMIT � <br /> (Complete in Duplicate)Application �s ' <br /> hereby mn6a to the Son Joaquin Local Health District for a permit foconstruct and install the work herein described. <br /> This |i fi is 6 in compliancewith County Ordinance No 549 <br /> JOB ADDRESS AND LOCATION........0__/_ i---------- -Vd-----------4 V'IF------------------------- <br /> Installation will serve: Residence Apartment House F] Commercial F] Trailer Court [j Motel 0 Other Ej <br /> Number of living units: Z Number of bedrooms 2- Number of baths It Lot size---- 14r �-------------------- <br /> Water Supply: Public system El Community system E] Private 91 <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam F] Clay Loam F� Clay F] Adobe X Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> (No ommfic funk or cesspool ponnwfeJ if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearestwell Distan e from foundofion------._Material ._':--_...-- _-----_- <br /> [] No. of compartments ���� � � ~n --------------------------------Uqu|d 6cp+ -------------------------- <br /> Cesspool- <br /> _._-_-_Cep9om- Distance from nearest well-----------------DIst noefrum 1oundn+ion------------------- Lining mutarioL_-___--..__�- / <br /> 11 Size: Diameter--------------------------------------Dept h--------------------------------------------------- <br /> Privy: Distance from neprestwell-------------------------------------------------Distance from nearest building'----'__-''___--- <br /> [] Distance to nearest lot line__--__--__._------.. <br /> Soopogo Pit: Distance to nearest well -'__�.-_Distance from foundation--------------------Distance to nearest lot line-''__._ . <br /> [� Num6ernfpits. Lining material SizeDiameter-- Depth <br /> - v <br /> �-=-� �' ~Dis | Field: Distance fromDistance to e-4s4s <br /> -------- <br /> Number � / -- � Length � each — �- �6� of trench-_ <br /> ----'---- <br /> / <br /> Typa of filter ma+o,io�;� ��.Depf� of �|formn+er|n| ' �-�---- <br /> Remo6eling 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 /> ordinan aws, and rules <br /> 'ce �Aregulations of the San Joa4$uin Local Health District. <br /> ,.~- -A -- ' <br /> n g s, efc.. must be filed Ph his appric <br /> (Plot plans, showing size lo , location of system in relation 4fol�l�s, build ation). .. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------ '�'�-''''''-__'''_ <br /> REVIEWED BY-_____..___.__.-.__-_���-���_�vu�'_--_-----_--_ DATE_--~^y-' /-* / --_____ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.'-'__.''-__-'-'__________ <br /> Alterations and/or recommendations:-.____--___--.-_-----__-_______.-.__-______-__._______________ <br /> '_- -.. -- -___-__.- <br /> wr- <br /> _------------_.-.-__~------_-_~----^°---_------------=---------..`-_-.--_----- <br /> _.__�. �� .- _--___--_`-_- <br /> _-- ~ ---------------_'''�---' <br /> ---------'--''----'---'---''''''-----------''- '---'''--''----''--'----'----' <br /> PERM|TN ---------- |S5UED_- � --------(Date)/. / R INSP15CTION BY:----------- ___-_-_._ <br /> Dute'-_.''-_�~�~-' /' '/��'-------'- <br /> SANJOAQU|NLOCALHEALTHDISTR|CT <br /> 130 South American Street <br /> Stockton, California <br /> sS-9-2w9-50 *-/639 <br />