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APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />Application is hereby made 'to the San Joaquin Local Health Distrid for a permit to construct an�jnstall the work herein described. <br />This application is made in OmPijance with County Orcli N Q�549. <br />JOB ADDRESS -AND -LOCATION ------------ Rt -2 Bor - <br />Owner's Name ( _( - - - - -t -------- ----------- <br />---------------- <br />Installation will serve: Residence Apartment House 0 Commercial F1 Trailer Court E] Mofel El Other <br />Number of living units: 'El Number of bedrooms �Q Number of baths 0 Lot �i_e <br />Wafer Supply: Public system Ej Community system [] Private <br />Character of soil to a"depth of 3 feet: Sand 0 Gravel E] Sandy Loam Z Clay, Loam E] Clay E] Adobe El Hardpan 0 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: �6 <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank, Distance from -nearest well-0�_A_'__Disfance.,frc,m foundation --------- 0 ------- Material-, --------- CO -- <br />,.Privy: Distance from nearest.well % <br />---- Distance from nearest building ---------- <br />Seepage Pit: Distance to nearest well ---------------------- Distance from foundation <br />VDisposal Held: Distance from nearest well_o�� --------- - - <br />----- Distance -from foundation ------- W ------- Distance to nearest lot iine-41- , io <br />------------------------------------------------------------------------------------------------------------------ <br />f the work will be done in accordance with San Joaquin--Cou-n . ty <br />ordinances, State laws, and rule's and regulations of fhG San Joaquin Local Health District. <br />(Signed) ----- ------ U <br />----------- (Owner and/or Contractor) <br />(Plot plans, showing size of lot, location of.sys+em in relation to wells, buildings, efc., must be filed with this application). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />'~ r= <br />lti/_ '--_-.''-_.-'__.'-_ 44 --------- '_-�r_- ^''--_---'--'''-_--__.'-_'''-_-'''-_''''_-.''~__-'''---''-----�'-_.''''--''--_--' ''''_---_----_ ---_--_-' <br />-------------------------------------------------- '-----''''--''--'--'''----' <br />PEKM|T N ISSUED---- <br />!Volv <br />--------- (Date) FINAL INSPECTION <br />Date <br />---- V - 6/511! <br />SANJOAQ0NLOCAL HEALTH DISTRICT <br />130 South American Sfneof <br />ES -9-2M v'm vv'/mv Sfockfnn. California x <br />.'/ <br />