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o - -- <br /> APPLICATION FOR SANITATION PERMIT � <br /> ' ~ <br /> (Complete in <br /> Application is � . <br /> anabv made' fo the San Joaquin Local Health District for o permit to construct and install the work =c herein described. <br /> This application is made in 'compliance with County [)r&n <br /> JOB ADDRESS AND LC0,ATI <br /> 0 _# ,f------------ -A---------------A-M-1---------------------------------------------------------- <br /> ------------- <br /> 77 <br /> Installation will serve: Residence I!$ Apartment' House E] Commercial E] Trailer Court El Motel [I Other Ej <br /> Number of living units: -0 Number of bedrooms;4 Number of baths V Lot <br /> � `,".=, Supply: Public system LJ Community system [:] Private <br /> Character of soil to a depth <br /> �uf3 feet. 3un6 [] Gravel [-] Sandy Loom El Clay Loam [] Clay [l A6uboHundoao [] <br /> . TYPE OF INSTALLATION ` ND SPECIFICATIONS: ' ^ <br /> (No septic fank or cesspool permiffed if public sewer is ovaUm6/w within 200 feet. <br /> y Sept' Tank: Distance from nea ` D��� f fo � �on <br /> No of: � �ma � - --- ''^~ """' '""""" ^�=�-' -x^�xx�/o�1V�` <br /> . compo nru-��-�y�{�---Cupuc|hc104'.-(m191^Si,e^S.-&�.1�'��/�'����Liquid depth---S�� �^ -- <br /> Cooq,ou|: Distance from namn:� wuU--___-Didanco �nm foundation--------------------Lining material <br /> ����---' <br /> LJ Size: Diameter-------------------------------------- -'-__-''-__-''-_''- '-'''----'''--'-- <br /> �Privy: Disf ncv'--fnom nearest well-------------------------------------------------Dis+ nco'from nearest building <br /> | LJ D|��noy.+oneona� |o+ |��______________.. `,�-'-----'—'-----'-' <br /> �Soopugo Rf' Dist nce'to nearestwoL�-----_�.D�+unoe from <br /> ' foundationD�+unoyto naan�+ �t |�e- <br /> '---- <br /> , L� Number of ---''Lining material _._---_..S�zo: Diameter <br /> ' Depf�`.__..__ <br /> '-------------- <br /> ------------- <br /> -Disposal <br /> ance <br /> rom <br /> foundation <br /> F�� � <br /> Number :� f lines___/_WA9 --------Length of each line-4/7i <br /> Type of filter material ------eW<,_Depfh of filter mafe'rill----- <br /> Remodeling and/or repairin � (describe):----- <br /> ` ^ � <br /> � __� U � '���' | <br /> � -- '-'-_- <br /> - <br /> i -'---- <br /> � -'--''----------------''-----------'-''-- <�c__y <br /> [ <br /> ppepare <br /> app <br /> ` <br /> on and that the work will be done in accordance with San Joaquin County <br />( | <br />' ordinances, State laws, and rulespin regulations of the San Joaquin Local Health District. <br /> . <br /> - ----- an or on�.actor) <br /> � <br /> -' ^ <br />/ y-mrp�noshow m����o+�f1oca}�nmfuys�m� iv ,m��on �u�6�g, ofc. mu ' 6e ' �6wily -�-------------- ' <br /> FOR DEPARTMENT USE ONLY <br />. "rruCA//um ACCEPTED u, <br />` KEV|EWED -------------------------------------------- <br /> BY <br /> uV|�0!N� PERMIT ISSUED "��/ - ------- DATE- --' <br /> _ --------------------------------------- DATE- <br />, AKoruf�ns and/or recommendations: --'-__----._-___-___.. ­'�---'_-~`��--'-_.-----� . <br /> � " ------_.''-__''''__.'---.__----____-_____-.__.__ <br /> '-_-_-__.-______''-'--___-__.--___''-__.''-_----__-..___-_-____--__-____. <br /> ___-_-_-__--..__-_--___-___--___..___-.-__-..__----__-.___--.____--.- .__._-�__--�- <br /> .-_-_--__--_.'-__-' ^ ''-__--_�--'--_-_''___''-__- <br /> PER��|TNo`��-��..��--- |S3UED--�r�.�� -_' Dv+o) F/N/\L |NSP��T|[>N 8Y'-------------------- <br /> Date <br /> � -_�/ <br /> � ~ �^ '' ��� <br /> , Da+o__'''-__L-'-�-�''e��.''_---'_-'__.. <br /> ^ <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT � <br /> |30South American Sfroe+ ' <br /> � Stockton. California�x-�-- wv�n *�/mm <br />