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' -_--_- _-~~-- <br /> � <br />| . APPLICATION FOR SANITATION PERMIT <br /> �. <br /> (Complete in <br /> ' <br /> Application is hereby mo6a to fhe Son Joaquin Local HvoA District for o permit +oconsfimct and install t6ewor �oro� �eo �6ud <br /> This application made.°""�. .^ vuv m compliance wifh County Ordinance No. 549. " � ' <br /> JOB ADDRESS Ad� 49CATION <br /> --------------------------------------------------------------------------------------- <br /> Installation will serve: Residence El Apartment House E] Commercial K Trailer Court Ej Motel 0 Other <br /> - -E1 Number of bedrooms 0 Number of bafhs [I Lot size-.. <br /> Number of Nving units, <br /> Wafer Supply: Public System 0 Community system E] Private <br /> Character ufsoil to a 6eof� of 9oef' Sand [� Gravel [� Sandy <br /> depth � po _ �n y Lvum E] Clay Loam El Clay El Adobe Hardpan �] <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (Nn septic tank orcesspool permitted R public sewer lsavailable within 200 feet.) <br /> Septic Tank: Distance from nearest well --Disfonce from foundation-------- ' <br /> ~ ~ <br /> Mofu,iu| <br /> L1 No. vfcomporfmunf,--------------------------Capacity-----------------------Size------------- . ----------------Liquid depth-------------------------- <br /> Cesspool: Diotunce from neone,fwsJL------D|stoncofrom foundation-------------------- m�fvriu| <br /> Size: Diameter_-'__._-_-._-Depth-_----__--._-__� ---�--------- <br /> LJ 3/privy: Distan'ce from nearest well-------------------------------------------------Distance from nearest <br /> building <br /> 6uU6� ' <br /> --''--''-'''-''- <br /> '- <br /> �LDistance to naarn� �t |�o <br /> Seepage Pit: Distance to nearest well -_-Di�n� �m foundation -----'D�~'~nca^f'o nearest lot line <br /> ---------- <br /> Numberof Pits---------------------- mufe6oL._--__-. D . Deof6� '_ �`D . | F��� �uncefnzm .~~.~ D|-u'`~ '` '^~'�,' <br /> Num6e, of |�~ of each |� ' - ��h � �� `�p--'---'- <br /> ' <br /> �y <br /> Typooffi|+v, mate6o|4aoffi|f*, mor�L . <br /> ------- <br /> "Remodeling and/or repairing (describe) - <br /> --''------'-----_---------- <br /> �--�_'-_---------------------------------------- <br /> ---------------------------------------- <br /> _______________-_'__'_-__'-__..__--' <br /> __ __ _ -' - --'-_--------_------------------------`--.-----_.-------------__. <br /> ._-__ . -_-- - _- .. . -----------'--- <br /> s app1ication and that the work--w-i-1-1--be--d-on-e--in- S_a_n__Joaq uin--Cou-n-ty <br /> ordinances, S aws, and rules ,xid-F s of the San Joaquin Local Health District. <br /> If (Owne� a or Co tractor) <br /> ron to wells, buildings, etc.. must be filed Pith this application). <br /> (Plot plans, showing size of lot, locafion of system in elaf Zor C 04 <br /> FOR DEPARTMENT USE ONLY <br /> | hereby <br /> / -- DATE....... <br /> REVIEWED BY' _________________�� __�_______��_______ ' ---- DATE -�'--''-~--'7-�-------------------------- <br /> �-~--�'—---'-�- <br /> -'BU|LD|NGPERMIT ISSUED ____________________________�___ <br /> ' <br /> DATE ' <br /> ------------ <br /> Alterations mnJ/m, re**mmwn6mHon* � _----' '- --'— � <br /> ________________________-____'____________________�_____^_____�____________________________ <br /> --____.-_--__.-_--'-_.__--_--''---_--._----__--'_~-�.-.___...�N--_�---_-__.-------._- <br /> -------'''-'----''''---''--''''--''''''--��'��-'---'---''''''�'-z��-''________________________.____ <br /> _--_--__-_-_--__-_-_. --_--_---___-__.__---'-___---- � <br /> �RM|TNo`^� ��� ISSUED- <br /> ---------- <br /> BUE[) <br /> _*_ _ '-_"�-�^ -�_-(Du1e) FINAL INSPECTION BY:-------- <br /> Date Da+�-__��- ~ ..�.��� <br /> SA/�JOA/�U/N LOCAL HEALTH DISTRICT ' <br /> 130 South An,o,�mn Street <br /> ES-9-2M 9-50 W�i639 Stockton. California ��_ ` <br />