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APPLICArION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date-Issued 7 1.2 A�plication is hereby made to the San Joaquin Local H4th District for a permit to construct and install the work herein described. T 's application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION... Installation will serve: Residence [] Apartment House E] Commercial T ailer Court Motel E] Other Water Supply: Public system X Community �ystem C1 Private E] Depth to Water Table_10- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] r Clay Loam El Clay 0 Adobe Hardpan E] Previous Application Made: Yes 0 No X New Construction: Yes 0 No a TYPE OF INSTALLATION AND SPECIFICATIONS: P - . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we1__/V,*/4_E'__Disfance from foundation---fO Mate riaL CR& ----------------R46.0w, Disposal Field: Distance'from nearest well------------------Distance from foundation--------------- ----Distance to nearest lot line-------------1---- Seepage Pit: Distance to nearest well----------------------Di'stance from foundation------_-----------Distance to nearest lot line----------------- Remodeling and/or repairing (describe):-, ----—---------%e' ------ --------- ----------t- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regu tions of the San Joaquin Local Health District. (Signed)-------------D-i;T----- ---------1Z Owner pd/or Contractor) (Plot plan, showing sife of lot, location of system in relation to wells, buildings. etc., can be plac on reverse side). FOR DEPARTMENT USE ONLY, REVIEWEDBY-----------------------------V__ -------------------------------------------------------------------------------- ---- DATE------7&_�;------------------------------------------ '--_''--�''-__'''----_-''_--'--''''--^-''__.'----'--_''__-'''�---',-'_-'''__.'__.-_''_-._-'-__-_ ._-_-_-__----_-_-.-_--__---_--_--'-_-.__-`-_-_-----_-.__—.__.___-.. ''---_.'----''__-''--'''_-''-_'''---�''-''''--''--. ''--.--'�---^�'^�_-'-�_''--_'-_--.'-_-'--'''-_- . n FINALINSPECTION BY------------ ---------------------------------------------------- Date------ ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT ------'-----'-----'—SANJOAQ0NLOCALHGALTH0STRICT /yo svmh amori""" Street 300 West Oak s+re"+ 132 sv"~mom Street xw North ^c~ Street Stockton, California Lodi, California ^x°nt""°. C°|*","i° Tracy, California � v ss-9-2w n'v| xv,/,ed W-z|nn