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_ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> 4� <br /> Application is hereby made to fhe San Joaquin Local Health District for a permit to construct and install the v�ork herein described. <br /> This application is made in compliance with County 9rd"Inance No. 5�4�. <br /> Owner's Name <br /> Address------- 170/,.Z. ------------------ x<------------------------------------------------------ <br /> Installation will serve: Residence Aparfm f House E] Commercial E] Trailer Court E] Motel E] Other F] <br /> Number of living units: ------ - Number of bedrooms ---1. _­Klumber of baths -----1. Lot size ------- <br /> Water Supply. Public system [] Community system E] Private Depth to Water Table .4 ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sancly�L am E] Clay Loam Clay E] Ad8ben Hardpan El <br /> Previous Application Made: Yes E] No �( New Construction: Yes No F-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> kbllw <br /> (No septic tank or cesspool permitted if;pu er is available within 200 feet.) <br /> Septic Tank: Distance from nearest well -Distance fro foundatjon__�& _�oM�aferibl------ - ----- - <br /> Tro 2f <br /> D;s osal Field: Distance from nearest well, Distance from <br /> ____ ------ Distance to nearest lot line-- <br /> [� Nu��, � | of / <br /> Tvpe ofj�+"r �� - Lepfh ength <br /> �|far ^''^ � " of "="^' <br /> aterial- - - <br /> ' ' -~_'''-'---~_--'--'- <br /> Seepago Pit: Distance to noveot °efL------.Disfunce from foundation__.--_D�+ ncnfo nearest lot line--'-''' <br /> [� Number of �t�'-'-'''-�ning mote�oL'-�''''_-3�e: D�meter'_------ '' Depth <br /> --------------------------------- <br /> Cesspool: Distance Distnco fnzm nearest well--------------_Distance from foundation-------------------- mutv6oL,--- ----'_.. <br /> ~. [] Size: Diameter '��-----_Deo+^—''-''�''''—''''---'-L|quid Copoc/tyr---------------------------gals. <br /> Privy: Distance fram nearest well��''--''-'-''''--'''-Distance from nearest building'� <br /> ' <br /> Distance to nearest lot |�o ----------------------------------- <br /> Rem <br /> . pairing � --- _-_`_.. <br /> '-'�--'--' ' --''------'--'^-----------------'--'_---`--------_. <br /> ________________________________''_________________________________'__''i_________' <br /> '-'-'--''''''''—''-''------''__'-__.'-_-.___-___________._.____ __-U <br /> -.--.------- <br /> . ,ere" mccor6unoowifhSen Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local_ HealthDistrict. j <br /> /���a6L� '^ ~°�� <br /> `_ ^___..~~,__.=...___..�"�=�_-.___.-^------_--____________-_-----------(Owner and/or <br />� my�__._____-____'-._------,------'-_--'---_-_----.`--_J'TR�)__-'----_U-._�� <br /> ----''-��fo�o' _. -� »�a of lot. location of system in .��f�n to �� 6uU6imy� etc., can 6n placed �n �ovor� <br />` -7� <br /> FOR DEPARTMENT USE ONLY <br /> --------------------------------- <br /> '---------'------------------'-------------'-'----'---------''----'------' <br /> '_-_-'-�-'''''-_-'---'''-''''-'''�_-'--'''----'''''''_--_''''--''--''-�'--'-'_�_'''--'---'-'- <br /> -'-'---'-''----''''''''_-' --_�'''''''-''''----_''---_-�''--- <br /> --'-'-'''' '''---'_ ''-_''' ''- ''-'-- <br /> �-' <br />| <br /> FINAL INSPECTION 8Y�--'- .��.-��^��''���~��' r--. Do+v---���� �~..�-��---�^^� �~ <br /> - ^. . �-- ----_-' <br /> SANJOAQU|NLC}CALHGALTHOISTNKCT � <br /> /30 »*ufh American Street 300 West Oak street /32 Sycamore street m+ North "C" Street <br /> Stockton, o°/mv,",^ Lodi, California Manteca, California Tmcy, California <br />