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APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />`~ <br />Permit No. <br />Date Issued --- <br />hereby mu6= to the Sun Joaquin Local Health Dist ric+ for u permit to construct and install the work herein described <br />This application ismade |n compliance with County Ordinance No. 649 <br />' c��� <br />J��8/\DDRESS/\NDU]CA�{}N-_---..��)�------- ��-..���[��t��..�--------------.----_.-_------_--.- <br />/ <br />Owne/, Nom�_--.—�_._-_-.-k��6&f�}n�--^=' -��-��/��' ----. P�one- <br />-_ � ' <br />Address -_. <br />Installation will serve: Residence 0 Apartment House Ej Commercial El Trailer Court C3 Motel E] Other El <br />Water Supply: Public system JY Community system El Private F-1 Depth to Water Table -------- ft. <br />Character of soil toa' Wof 3 feet: Sand [-] Gravel [] Sandy Loam El Clay Loam 0 Clay El Adou� Hardpan� <br />_�k <br />Previous �� �a��� Yes [� N~h� New v~' 6� No[] <br />-- .,_._ .�� . .~��� <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />L <br />(N* septic tank -Or cesspool permitted if public sewer is available withiA 200 feet.) <br />Septic Tank; Distance from 7Y <br />/N <br />D|s a|'Fie|d: D/stunce from nearest w°|L.- 5'A ...... <br />Distance from fnun6ufion--2Y' ..Dist <br />unoo to dearest lot line -_�'/- ' <br />Number of lines-- <br />L"ng+h of each |inn..&���Q_..V|d+h <br />` <br />o[f,e`:h---..--_-. <br />^ <br />of filter mu+o�ui..A.--.' <br />^ <br />° o| -.,_)_y./( --.Tot <br />| length -_1 --.-�._---__ <br />3uepugo Pit: Distance to nearest welL_--_-.Distanca <br />from {oun6of���_�-__- <br />Distance +n 6nun*st lot line ----------------- � <br />[� Nu�n6orofpits ---�-_---Un�g ma_f�aL_.------5�e:D�motec�----'— <br />Cesspool: ' <br />Doptk._. l <br />r``' ~'^'~^`~ ^~^' '~~'`~' ~�' <br />� <br />[] SizeDiameter <br />~� <br />Privy:� Distance from neare'st <br />Distance from nearest 6ui|6�-ing- ''! -� <br />E] Distance -to nearest |o+ |�o <br />� <br />-_-_--_--.__'__.------------------- <br />'---_-----'--'----'------.- <br />Remodeling and/or re'airing (describe) � <br />�J . <br />. <br />`P <br />__'-_--------------------- '_-__.'_-------------------------------------- ---''--.'_-.-__--_.'-'-'-''---_�._-.-''-'---'_-- <br />-----'_---_-'.__--_-___-_-_--_-'�'._L-__--__-.___-_-____________ (.__________._.. <br />/ ^ <br />--'-'-'--.-'''_��-----___�______--__'--_'.-_.__---__.._____.__--__.--__.----._-----. ` <br />I hereby certify f6t - I have - prepared -this-ifppliemibh -grad tho -thc. work- will., be done in accordance wi.fh San Joaquin County <br />ordinances, <br />(g"=")--* ----------- ----- (Owner and/or Contractor) <br />(Plot plan, showing size'of lot, location Of system in relation to wells, buildings. etc., can be placed on rey4rse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ----------- ------------------------- I -------- ---- DATE --------- -- / -, <br />---------------- <br />Z". _)" ;,, L!e ------------------------- <br />SANJ<]AQU|NLOCAL HEALTH DISTRICT <br />/m South American Street 30mWest Oak Street wz Sycamore Streee14 North "C" Street <br />S+""kf". California Lod;, California Manteca, California Tracy, California <br />