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--- / <br /> -7 | <br /> . APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> . � <br /> U <br /> Application is hereby made to the Son Joaquin Local Health Dist6ct for n permit to construct and |ndoU fhework herein described. <br /> � <br /> This application is made in compliance w�fhCounty Ordinance No. 549. <br /> � <br /> JOB ADRRESS AND �qCATION____Ak__,�---4 <br /> � -_- <br /> --------- --- - ------ ------P��_ - <br /> h <br /> i' � ~---- <br /> -----------------------'' <br /> �Conf�cfors Name' _° = <br /> Phone----- <br /> Installation will <br /> |nmta|lafionwill serre; Residence Apartment House [] C6'm-movcia| � '-_ �� _�'- � <br /> Number of /k,|ng unA`Z Number of bedrooms nL Number of baths A ^Lot size <br /> .. .~------------------------------ <br /> Water <br /> _-----,- <br /> Wat , Supply: Public system [] Community oy,+em [] Private <br /> Character cfsoil to a depth of feet: Sand El Gravel E] 3a'ndy Loam [] Clay Loa`m Clay [] Adobe E] Hardpan <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: ~ �� <br /> /No mmpf|c.fan»~o, c*xspoo| pe,mift-e6 Rpublic sewer is available within 200 feet.) - <br /> D,.Septic T <br /> pnk. istance from n°o,es+ ~eU------_0�unc -from foundation-----_---k4oferiuL_-_-----.---.-_. <br /> � ��x���1 p-'1 No. ofcompartments--------------------------Capoci+y'---------------------Size--------------------------------Liquid depth---_-.---- <br /> Caspoo|: Distance from nearest well-----------------Distance from foundation--------------------Lining material -._---._._-._- ��� <br /> [] Size: Diame+n,'_-.-_.'''__�_-.Depth----:------------------------------------------------- <br /> Privy: <br /> '''---''''-----''''--Privv: Distance from nearest well-------------------------------------------------Di ' nco from nearest building-_-_--___. <br /> [] Distance to nearest lot line-.'__--__------.______ <br /> / 3e Rf Distance to nearest well Distance from foundation � - <br /> -Depth <br /> ---- <br /> Disposal FJu|6: Distance from nearest w�7i'��V.,.'-Distance"��o�� fo� n�o+�n-����.� --Distance~- -�' . ` - '---~~���~-�-�-- <br /> Number of lines �� ' Length � each |ina-..1�^�..'~ ��i6H` offrench--��.�Z^ar line� ---' <br /> Tvoo of filter ma+edaL..��, 0 <br /> i--Dep+ o� fi�ur mo+v�ui -_ <br /> _ ` <br /> , <br /> Remodeling and/or repairing (describe): <br /> i .--_-�-----_----_-.--_.________�__�^___��_._________ �___^..� _.~ ___.._________.. <br /> . � . <br /> .----_-__.-__.--_-_.______-._____----.__-_---__-__--.--_-. ------------------------- <br /> I hereby certify fha+ I ha repared this application and that f he work will be done in accordance"with San Joaquin County <br /> ordinances, State laws, and FT-V nel regulations of Joaquin Local Health District. <br /> (Signed) <br /> / ' . <br /> ` " ze of lot. location of syste in relation to wells, buildings, etc.,,must be fi <br /> �m, p�n� show m� <br /> F� <br /> | �omo����| <br /> / <br /> ' �� <br /> � APPLICATION ACCEPTED BY------------------------- __-. ------------------------------------'DATE__--- /'m���'���-____._ <br /> REVIEWEDDATE <br /> BY <br /> DY-BU|LD|NG PERMIT ISSUED_--..__-____-.__ 1D�TE <br /> l-''--'''-- --�---'---~-~--' <br /> _- -_- <br /> -N�Alterations-onu and/or rn-commrecommendations: <br /> .__�-..�-�.._. --_^-_` --,+� <br /> -_. <br /> .-�.--__-..___..__---�_�_-_ <br /> .--_---__-__.-..__---_-___._.__---_-`..__.-.--__---_--___-__-.__..--_.-~- <br /> .___-.- <br /> __-.__.--- <br /> ____________-____________________________'____`_____'________________''_____''__________-_ <br /> ------------------__------'__--------'--_������------___�---'__------__------'------'-----__------'_��---_---------__------------______--------_����������---------' <br /> _.-_- � ' ^'''-''-_--'-_.''__-''''-- -__'-_-_. <br /> PERM .'_ --. |SSUED--- .(Du+o) FINAL INSPECTION ^ __---__- <br /> « Dafo'--.''- <br /> SAN <br /> ����U|N LOCAL HEALTH DISTRICT <br /> |DU South American S+neaf .` . <br /> l Sf��k�xn California <br /> � ES-9-2M �'oo W-1639c ' <br /> fo <br />