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APPLICATION FOR SANITATION PERMIT Permit No. -J-------- ......... <br /> (Complete in Duplicate) Date Issued _7/nA) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> his application is made in compliance with County 0;rdina ce No, 549. <br /> t A- <br /> Z�"LOCATI _lu. louz� <br /> Installation will serve: Residencev, -Apartment House L] Commercial E] Trgiler-Court [j Motel [I Of her lj�,i2z, <br /> Wafer Supply: Public system El Community system E] Private Depth to Water Table 0A ff. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel El Sandy Loam El Clay Loam El Clay 0 Adobe 0--/Mlardpan 0 <br /> Previous Application Made: Yes 0 No E] New Construction: Yes [] No [] PHA/VA. Yes El No It�- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � <br /> No septic tank or`cmospno| permitted ifpublic sewer isavailable within 200font.) _ ^ <br /> ' ep <br /> D�x+uncofnomneurus+ we|L----.-Di,tonoefnmfovn6uhon--_----MafurimL-------.-_--_-__ <br /> �° �^� No. of compartments . .� ---Size . ..- Liquid 6=R+h_-.- ----.Cupocify .. <br /> D[spoxa| �e|6: Distance f U.JZ� f fp � �_ <br /> Number / ' <br /> Type of filter | +k of C <br /> Seepage Pit: Distance to nearest . .�--D oun6otiom-'_�a�.' nearest �+ |i ..� --. <br /> Number of pits-.��----..Li�ing mu+orio|'/� --.Sizv� Diome+e,.��x��..��-Dcpth..�w«���----------------­ <br /> Cesspool: Distance from nearest well-----------------Distance from foun6oHon _---------Lining mvferioL_---------- , <br /> [� S�zm: Diumotec-----'-----..Depth-------------------------------------------I----------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well ''--'-'''.'''.-''� ----Distance from nearest building '�'�'''--_-_---- ° <br /> Distunm, fvnean,st |nf1in°--------------- r__..__--------�--_--.____-._--_---_ <br /> ' RemoduSng and'/or repairing h600z6e\:--'''-'''''''-''-_' ---'''' ''----'_-''_-'--''-_.'''--_' <br /> '—'----'--------------'--------'----''---------�-------------'----'----'—''--' <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 14- <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Healfh District. <br /> DAY&NIGHT <br /> (Signed)--. . <br /> -7046 <br /> 1206 So.Eldorado HO 2 <br /> ' S�q C(Plot plan, OW g size of I ton W ��-- ------------------------------V_ --------- on reverse gm in � . <br /> FOR DEPARTMtNT USE ONLY <br /> mruCn/mm nCCcncu o/ um ' ` <br /> REVIEWED BY------------------------------- DATE--- <br /> PERMIT ISSUED--------------- ------------_.- --------------------------------- DATE_ -.----------__.. <br /> Alto,mtions mv6/o, recommendations------------------------------------------------------------------------------------------------------ --.--_--_----. <br /> --'--------'--'-----'--------------------------'-------------'-'----'--- <br /> -------------`---`---`---------``----------------```---`-------```---````----```---``----`---------``````---````---------`------``--`---------``--`-----``--------------------------- <br /> ' <br /> ----_-----_-----_---_-----____---------_---__-------_-----__-------___--____-----__�_---_----_�__------- ------------------------------------------------------- -----------------' <br /> ---''-''---'''''-'''-'''-'''--'' '-'''---'''-'--''''-'''''—''''-''---''--''--'---'-'-- <br /> � <br /> RNAL INSPECTION. BY:. ~ ----.. Date--- ..�'��.�! <br /> " _ . . lJ ' <br /> ' <br /> ' SAN JOAQU|N LOCAL HEALTH DISTRICT <br />- � /� �� ��" s� 300 West � s� /� �� S� m4 ^� � Street ' <br /> ~. � � <br /> Stockton, California Lod/. California Manteca, California Tracy, California � <br />