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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> A�cJb — <br /> of ' <br /> i horo6v made to fhe Son Joaquin Local Health District for a permit to construct and install the work described.konein �e�� �e6. <br /> ~npp|�| fini'�rdo incompliance with County Ordinance No. 549. <br /> Resider Motel p Other [I— <br /> Insfailation Will serve. -1�c. �A�pprtm.n' House E] Commercial E] Trailer Court [:] P.6 <br /> Wafer Supply: Public ays�,m [l Community system [l Private El <br /> Character'ofsoil toadepth of3feet: Sand [] Gravel F-1 Sandy Loam E] C|oyLoum [] Cloy [] Adobe e Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ~ ~ <br /> (No sepfic tank or caospn*| permitted if pu6Un sewer i, a"ul|o6|e wit hin.200 feet.) <br /> Septic Tank: Distance from nearest well-77!=-Distance + - <br /> -- Nu ofcompartments-----------� � —Copncify--� c�-----Size---- Liquid °,r^----\ ---'-- <br /> � <br /> -- �-f,un6o�on . Lining' <br /> material <br /> -''. <br /> __.`- <br /> Cesspool: Distance from nearest well ' . D�tonm, fn,S�a� D�m�+ec_--__-'__.'`—_'Dop+ —_--'�—__-''----''—_ <br /> Phvy- Distance from nearest well-------------------------------------------------Distanca from nearest building------------------------------------------ <br /> E1 <br /> ----_.-------_—L1 Distance to neuno�' �� |�n� '' <br /> --___----_''—_.'' <br /> 3aopmgo Pit' Distance to nearest well----------------------Dis+un�� from foundation--------------------Distance neure,t lot kma <br /> __—_~_.— <br /> ' <br />' F1 . Number of pits - —_Lining mm+aHa\ Size: Diameter------------------------Depth_- � —»,_'-_~AV <br /> ,Disposal F�� Distance ea1-11 nearest lot v---------- <br /> w <br /> ^_-- <br /> .. K <br /> - <br />� ^~ � ,.".. .. trench----------- <br /> Number of linesLength cfeocxnej <br /> Typo of filter mate f �� f �� � �� _ n <br /> � ` . <br /> Remodeling and/or repairing (describe)�---. --____.—.__-__.��''___'—_—''—____-- <br /> ` --__________'..__--_____�'.--__'.___--.-___---____._._-_—.`..—__—�'---____—_--_—___—_. <br /> _—_._—.--__.-'---_'__.—_--'—__-__—'____'---_-_—_--'--^_.'''___—''__.--_____—'---__.- <br /> . - .__._---_____---_�---__---__—_---.—__---_—____--.__-. <br /> reby <br /> car <br /> tify <br /> that <br /> ' --'-------'--'------------- and that the work will be done in accordance with Sao Joaquin County ' <br /> ave <br /> prepared this application <br /> ordinances, State law* and mmm and regulations of the San Joaquin Local Health_ District._ _ � <br /> ' _—..__-_--'__._.—_—�_---__}Ownoron6/orC°ntractor <br /> —___'''--__-''''+".=+_'-_—._--__-__._.__.—'-- <br /> my�__'---'-----------''-'---'—'---''�'— 6* ��� *�6 this(Plot plans, showing s�enf�f. |wcmHon ofoy�emin n�a�unfoweUs. buildings, etc.. must appxcanon>, <br /> FOR DEPARTMENT USE ONLY <br /> � <br /> B"'LD^`G ' ERM ' ISSUED--------------- <br /> Altarationv and/or recommend ations:------------ --------------------------------------------------------------------------------------------------------------------- -------------------------- <br /> ----------------------------------------------------------------------_----__'''—_.-''___-''—__---'___'--''__—'___''__.—_'_—_--' <br /> ___—._—_--__--._—.___--.____—__._.--__.—.____—____—.—_-_.''--__—''___--__'—_—_.'__�. <br /> ____.______________.—.L..-�-_-----------'--------''-------------''''---'----''--'-- <br /> _—.���—__---__''--__�'' —'''� <br /> |�3U--�- ^/ (Do�� �N/\L.|N5PB�T|{}N 8Y ------------ <br /> .. — —/`�'—_--_._— <br /> P5RM|T Np---6�� ��—.. �un _. ------------ _ �^ / <br /> Do+n'—_.--��.'^�''. --------------------------------------- <br /> SAN <br /> ---__'--'__.__.- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 S*ufh.AmoricanStroof <br /> Stockton, California <br /> \ <br /> ES-9-2M 9-50 w//639 ^ <br />