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\ � APPLICATION ��OR SANITATION PERMIT in Duplicate) " Application i, hereby made to the Son Joaquin Local Health District for o'permit to construct and inofo|| the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ --------r -v�-~ -,---___-_---.___--__...__'._ Installation will serve: Residence [7 Apartment House F] Commercial [j Trailer Court E] Motel E] Other E] Wafer Supply: Public system Ll Community system E] 'Private V Character of soil to a pth of 3 feet: Sand -- Gravel -- Sandy Loam E!('Clay E Clay E Adobe ffr"Harclpan_ ^~ ' TYPE OFINSTALLATION AND SPEC|FICAT�NS� . (No septic tank or ---'-- permitted ifpublier-~ is available within 200 '~^ / Septic Tank: Distance from ' from n------------ ' No. of compartments ----Capu-ity_:3 . _"�:.Siza__.—__'_-'.-.-Umuid depth------- ---------------- »` � [o`spook^ Distance from nearest well------------------Distance from foundation--------------- mmtohuL_-._--__--- ' [� `3bm: Diameter--------------------------------------Dept h-_'-__--'''-_.-'''___----- v ' y,ivy: ' Distance from nearest well-----------,-----------------------------------Distance from nearest 6u/>6ir�6-_�---.__._.-_- El Distance tonearest lot line------------------------------------------------ ` ' Seepage Rt: Distance . Num6o of ----le . ~~r Dio��-.F-�`�-.h- Distance - ' --------- el Number of | [e�th of each � Width of +mmc� �- ' �^ e � �|�, r��riu^ Dun� � filter ma��^|' - — � ` ' Remodeling and/or repairing (describe): � ' . _ '---'''-_�'''-__''-�-______-______--..___._�_.-.__._--_-__--- � ---------------------------------------------------------------------------------------------------------------------------------------------------- ---7------------------------------------------------------------ | � --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---'__-___._..___--__---..__-__'___--`--'_-._---�_---__-_�_.-..__--.^-.___.--__-__-__�-_.ordinances, State laws, and rules and' regulations of the San Joaquin Local Health ^ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County District.-- " (signed)c ''-'''_-�''_-. and/or --.- --------------------------- ------------------------Ti koj---.-_----------_----------_--- `- ("lo+ plans, showing size of lot, location wfsystem in relation to wells, buildings, etc.. must be filed with this mpp|lcarioo)' FOR DEPARTMENT USE ONLY J ., APPLICATION ACCEPTED 0Y----------^°��.°e��.,��__�� --------------------------------------- DATE_ � REVIEWED BY------------------------------------------------------------ -------------------- DATE_.--./�._,��.��..^_�____�_ ^. BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---''-__.''-___'--_-_.'__' � Alterationsmn6/orroc*mmwnJmtions:-_---_------------�--.--_--��-------_---_--------------.--_--__-_- _ � '__'____.-'__.''''-'-'--_-'-_-___.-____-_--__-..___-.___--.__-_.__-____.-.__-___-___~_ ------------------------------------------------------------------------------------------------ ---------------------------'`�� ------------------------------------------------------------------------------------ _____________________________________'_______'___��___________'_____________________________ . _---__-_------ ____--___._-___--'_--.. ----.__. ' � � PERMIT Nu'��&�_-.. ISSUED---- -._(Du+o) FIN/\L INSPECTION BY:--------- ------------------------------- Date -. --..___oote-------------------2(_1 '-------------------------------------- SAN ---'-�''---''---- SAmJC}AQU|N LOCAL HEALTH DISTRICT ~ 130 South American Street `�' ` Stockton, California ` ^ ES-9-2M 9-50 W-1639 �