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Permit No. <br /> PPLI ATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued ____`�7/ <br /> Application is hereby made to the San Joaquin Local 'Health District for a perm�t to construct and install the w rk herein descri e <br /> This application is made in compliance with County Ordinance No. 549. <br /> .- _f� - --------------------- <br /> JOB ADDRESS AND LOCATION..- <br /> ----------------- <br /> -------------------- <br /> Instailation will serve; Residencej9L Apartment House [I Commercial E] Trailer Court E] Kjotel Other <br /> Number of living7 -units: j------ Number of be ---/__ <br /> De' fh to Water TableA_ft. <br /> Character of soil t�o'a 4 depth of 3 fee+:. Sand r-1 Gravel F Sandy Loam El Clay Loam E] Clay [I 'AdabeK Hardpan El <br /> Previous Application Made: Yes New-Constr-ucfion, Yes [I No FHA/VA.. Yes E] No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank or'cesspool permitted if publie s'ewer is available wi+hin 200 feet.) <br /> Septic Tank: Distance from nearest Disfanc 0.1 -------- <br /> Disposal Field: Distance from nearest weIIC_�___ ___-__D'isfance from'- 01 4�1 I <br /> ------------ <br /> ------------------- <br /> Type of Filter materia 'D lsta`nEe t ares ine:.--- <br /> Distance to ne <br /> Distance to rearest <br /> IJ <br /> -Distance to nearest-lot Ii <br /> lin and/or repa�ring (de <br /> I hereby-cerfify that I have prepared this <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ----------------------------- <br /> in relation to wells, buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lotjocation,of system <br /> FOR DEPARTMENT USE ONLY <br /> REVIEWED BY--------------------n---' --- 7- <br /> DATE <br /> _4P ------------------------------------- ------------------------------------------------------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street manteca, California Tracy, California <br /> Stockton, California � Lodi, California <br /> ss--(1-2w . n°.is°a 1'57 rpco <br /> _ _ <br />