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APPLICATION FOR SANITATION PERMIT Permit No. '� ^ � � (Complete' 'icat` Date |,,ue6 . . Application is hereby made to the San Joaquin Local Health Disirict for a permit to construct and install the wo4-4erein clescrib d. This applicationi.is made in,compliance with County Orcli�nanc No. 549. Z,0 ` ^��^,j ,�O^�-+a*m�'c��^� ^ J � ---------- Owner', living �4x-- ---- -1-------------------------------------------------- Installation will serve: Residen Apartment House E] Commercial F] Trailer Court E] Motel E] Other E-] Number of - Numberbaths_ -'- _ size _--'-'--'''---'-'�_-�_�-' ��r Supply: Public system 0 Community system E] Private ��n n� to' ~ r Table 6 ft Character of soil to m depth � � �� n6 [� ��`� � ��y Loam �� Clay Loam [� �� Adobe � , Hardpan 0 . �� Previous Application Made: Ye, [] No [:�' New Construction. 1q .,�«��' Yes �� No E] FHA/VA. Yes E] m~��" =� TYPE OF. INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well__�� Dista f n fou�afjpj�. M f)ria No. of compartmerifs .. Dislio�ql Field: Distance from nearest weII_,,,j�0____.Disfance from foundation ---3-��_Distance to nearest lo�line-,5- Number of lines ---------- Lengt� of each line--------;�f,_,,,_.Widfh of french-- 1'1� 4Z "�w Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-- ------------- Cesspool: Distance from nearest well----------------- from foundation �� --------------Lining matoriaL-'''-'--'--'''- �[] _ ^ _ ^S�zei Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy. Distance from nearest well-------------------------------------------------Distance from nearest building-_''_-''--__.--''. Dis+anov to nearest lot |ino--------------------------------------------- -_..__._-----__-.-----_--_-_----. ' R°modeling and/or repairing (do« �be):---''-_-'��________._______.____.___._____._______._______._____,__ __.--_--------------------------_-_------_...--------.---.--_-.---------_--.---_-.------- --------'''--'—'-------'^---------'-'—'—''---'----''-----------------'---------' 7� _'� '-_------''---'__-''-_-.'___.__.'''-'__---'-_.---__-''_--''__.'----__-''-----'-''-' I have prepared this application and that +he work will be done in accordance with San Joaquin Counfy ordinances, State wsk, nda rules and regulations of the San Joaquin Local Health District. ----------------------- (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED DY-----. ------------------------------------------------ DATE REV|Ew�B} DY.--'-___--_--. 1-6 ~° BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------- _-'-''- Altw,mtions and/or recommendations:------- ------ ----------------------------------------------------------------------------------------------------------- ---------------------------- ---------------------------------------------------------------------- ----'------------------------'-------'--------'- ----_-----_-----_---------'___-----_-------__-------__--_��---____--___-----__-------___-----__------'--__----------------'_-------___-----__---__-----_-----_------'-----_----- --------__------__------ __��__-------__-----___-----__------___---___-----__---------_---------__-----___---_---___-----__-----___---__---_---_--_---__��---_ _'--'-'''''''--''�-'' ---'''-'''�-''�'_'��'--''_-'''--'-'---'-''_-''-' � \~^ F|N/\L INSPECTION BY:.. - . -.- Du+o----------��------ ----------------------__� SAN JOAQU|N LOCAL HEALTH DISTRICT /oo s"mh American Street 300 West Oak Street /31 Sycamore Street ow North ^C^ Street m="k+"". C°Sf","|° Lodi, California Manteca, California Tracy. California ES-p-2M . Re~/"°ci 1.57. �p� . �