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\ ' <br /> - . <br /> h� APPLICATION FOR.-SANITATION PERMIT Permit N* � <br /> . ' � � °~ <br /> »�� K r~°`r=`° in Duplicate) Date |suaed �� �!^�'- <br /> �v « . . ~^ <br /> ' <br /> Applica-lion'is hereby .made to the San Joaquin Local Hoo|H` District for u permit to construct and install the work herein described. <br /> This application i, made in compliance with County Ordinance <br /> ------------------------------------ <br /> ------------------------------------------- Phone-------------------- <br /> . Name_:D <br /> � <br /> Installation willTrailer. Court. W [] <br /> Number of living units: C of-bedrooms '4--. Number of baths -I.- Lot size -------�7.--_' <br /> Water Supply: Public system 0 � [�mun� o�m��/ 9�� � Depth � �� � � <br /> 4 <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam E] ^Clay [I Adobe O��rdpan � <br /> Previous Application'Made: Yes El No R~_ New Construction: Ye, M;�1No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ' <br /> (No septic tank or compnn| 9o,mhfed if public sewer isavailable within 200 feet.) <br /> Septic Tank: a,~�Distance from nearest wa|L-. -- -Dl,fm��Jfro= foundation_.�----- � ------------------------------------------------- <br /> No. <br /> ---------------- <br /> ` No..' ofcompo�men+:-----.�-�--�--�..Size------------------------------- <br /> . <br /> Liquid d'u�o.h_--------------------------Capacity------�.-'-�-.. <br /> . <br /> posal �Field: -Distance from nearest well-----------------Distance from foundation-------------------Distance to noan:� lot line,-____ <br /> J Number ulines-.-'--'''-r�-'�Length of each line------------------------------Width oftrench--- -''_------'-. <br /> Tvnn of filter material - .---'Dvpt of filter muta�uL-.-----7q�| �motk------.--- <br /> 6ee � : .Distance to 6 n-4& , +o nearest lo, .. , <br /> Nu`mborqfpits--1 - <br /> material ��Sizv: Diametoc-..��_' -''Dep+k����~!r�-.'--- <br /> Cesspool: ~` Distance from' nevres weU--.---Distanco6nnjf"undotion- ...... ----Lining material --.---.--__ `~ <br /> Sl�o: Diameter------------ -------------------------Depth---------------- �''-''--''--'-Liquid Copocity '-'--'--''-gals. � <br /> ' <br /> . <br /> Privy- D;sf nce from nearest ��U ' - Dist�nu, from nvun=r6ui|6|ng ' - <br /> q� <br /> | �] <br /> Distance to nearest |o+ Une--- -- - - - -^---- --- - - -- - - -- - --- - - - -- - _- - - - -- - - -- - - - <br /> _. <br /> . ~ <br /> . . .=� <br /> \ � ' 8 �� \� ~ lj r� <br /> . .. - -----'--''-----w----'--'t�'----'----'p--'----� --'------ <br /> '-''-''-----�''---\f-'--------'-------'---'---'--'' -----''------'''-`-'-'----'---''-''----- <br /> - -- -'- - - - - - __- 2..- ______~___`____.-=___ - -- - -- - __--- -___-.-.c-_-.-.- ---- - - - - - - - - <br /> I hereby certify that | have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinancep-State Iawsj and rules and regulations of +he San Joaquin Local Health District. <br /> ,."n- ____ <br /> ' � �ne_m � ��, on � �� �m/ mmgs �� can be on s�eL(Plot plan. showing �zn Of location � ' <br /> FOR DEPARTMENT USE ONLY <br /> ------- .-..Z—�---����I--- �-.�U-.. 4"���~��������--------___.-________________. <br /> '--'--'-^=�^---'----'--------------'t\'-------'---'--------------'--------- <br /> �-''---'''--'---~- -'--''_'''--'--'''-'''--''--'-''-'''--'--'------_.'--. <br /> _ <br /> HN�L INSPECTION 8Y�-�� ''''-'''-''-- Dm�--j�!.--.'v�����_--�=l � ---------------------- <br /> - � <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /30 south Americ-an Street 300West Oak street` /32 Sycamore Street 1114 North "C" Street <br /> Sa""e+o", California Lodi. California Manteca, California Tracy, California <br /> � ""_~_," ~~^".~.. .,= <br />