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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> T�,Ii ation is hereby made to the San Joaqu;n Local Health District for a permit to construct and install the work h I rein described. <br /> application is made in compliance with County -6 <br /> JOB ADDRESS AND LQ�CA�ONY <br />, <br /> Contracto <br /> =�~ -_ .~^~�'~. <br />� N«m��' of living unH,' \Num�e f ~ -- o ��m-r-- [: '' ' Motel~'` ~~"'' �� "'*/ �� Other [] 1 <br /> . , obedrooms1�-~Num6or of baths rh Lot ,�e ~3 <br />' W� �o� Public system ` Community system ���� �( � -��' �I--- <br /> ��om���s� � a 6�� �3 �� Sand �� �� — ' <br /> . w� ay Loam �� ��u) r� Adobe E] Hur6oao <br /> TYPE ��F |NSTALLAT|��N /4NDSP6C|PICAJ|�]NS: ' � <br /> .1' tzz, <br /> . (Nm septic tank nrcesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nean-+ <br /> wo||' ----- ��-- <br /> No. ofcompo�mon+,------------ ' - ~ - -- - - -- --_----'_~ <br /> --------- <br /> X <br /> '-- <br /> Paferial <br /> iz <br /> X --------� ---------- <br /> ria <br /> --- <br /> u/Size: Diameter ��Ceo"o" : Distance from neony� wvL.___--Distance �odu ' - """ " <br /> __�__ ____ ___ <br /> Pr�v Distance from nearest woU_. ___..-_.''---_-___'Ubfuncv from nearest building-------------------------------�--- <br /> - <br /> R Distance to nearest lot line <br /> Seepage Pit: Distance to nearest well-------yo-------Disfance/f m o n n- <br /> Pisposal Field: Distance from neairest-' <br /> 45 <br /> Distance <br /> (00 <br /> Y=, " ^ ~ �,,.~~ of lines_ of each |�- --- V� - -n -��-- <br /> ---�^ <br /> . +" of " nc�Tvpe nf �8e, mofa�afilter material -�� <br /> Ramodelingon6/ormpairing � <br /> '_-.________-.___'____-___.--__-_-___.._-'�_-.__-�-.___.'--___.--'_-'-_. ----___-_- <br /> 10 <br /> --'---'-'-----''---------'------'-'r---''-------------''------'-'-__________. �--- <br /> / pre; . <br /> is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S. 4 laws, and ru�les arKle' regulations San Joaquin Local Health District. <br /> /f reg 1-o <br /> .... .....�k <br /> (Plot plans, showing size of lot, loc�afio of system in relation to wells, buildings, etc.. must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY' <br /> ._-___-_-_-- DATE <br /> REVIEWED --''' <br /> ----------------------------------------------- <br /> Alterations and/or recommendations: <br /> -�r3 ------------------------- ---------------------------------------------------------------I------ <br /> Date <br /> SAN JOAQ0NLOCAL HEALTH DISTRICT <br /> /30 South American Street <br /> ES--9-2M v'nu \v'/mp Stockton. California � <br />