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APPLICATION FOR �ANITATION -PERMIT Permit No. <br />--------------------------------------------------------- <br /> Application is hereby made to the Saln Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> Intfallafion will serv6: Residencet] Apartment House Commercial E] Trailer Court E] Motel 0 Other <br /> Water Supply. Public system (3 Comrnunity system El Private [-] -Depth-to -Water Table __65 ft. <br /> Character of soill'to a depth of 3 feet: Sand F] Gravel 0 Sandy Loam E] Clay Loam [3 Clay [3 Adobe E] Hardpan 0 <br /> Previous Application Made: (If yes,clote!-------- ---------) No [g New Construction: Yes a No 0 FHA/VA: Yes [I No Ek "Vi <br /> TYPE,OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> . <br /> Disposal F�|d:' �D�+unco from nearest woL.-'-'--Distance from fov +ion--------------------Distance to nearest lot line. <br /> E�Us t img Number of lines-----------------------------------Length of each line... ^---'_-Width oftrench.................................. <br /> Type of filter matoriaL-_---.-Duoth of filter material----------------------- length.......................................... <br /> � Distance to nearest |LAq-------------Distance from foum6ofion1.0.. Distance <br /> - <br /> Number ofpits........ -----------Lining material .-rg.Qk------Size: Dia meter- Depth---�9l.- ------- <br /> Caoq000� ~ _ D�t noo fn,m nauno� wa|L.---'Db+ancn from foundation---.---Un(og material <br /> [] Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well -----.-__------Distance from nearest building-------------------------- ---------� <br /> [] Distance fonearest lot-line---------- - ------------------------------ -----------------------I--.._-'--_.--------------....................I---_-. � <br /> Kemodel|ng and/or repairing (6eupibe)'-----a ---q-0-epoge-�zi-t-..- -_-_ _' <br /> -_____-___..._______--__---__.__-__-_-----_..__--_--___._.______'--_-----.-------_-. <br /> '---------''---'--------------------'-----'-----------'''------ ----'---' <br /> -------------------------------------------------------------------- <br /> I hereby certify that I <br /> have prepared this application a� �� t� �� w� 6m �� � n��6��-�� S� ��� <br /> ordinances, State |aws, and rules and regulations of the San Joaquin Local Health Oi��c� ` ' ' <br /> (SignmdL--.�\�.I]t��-(�������/�,�-(��{�..���l��C�-���i��-������z�``�-Z�(��-------'�'�����}[�mw� �n�/�, Coo�mmtor <br /> Bv:-----------'.Perr/----l,AY%r-thaQ---------------------------------------------------------------------Rifol...... --------------------------------- <br /> (Plot mlan, showing size of lot, location of system in relation *mwells, buildings, etc.. can be placed on ,mvmme side). <br /> FOR Df PARTMENT USE ONLY <br /> BUILDING.PERMIT ISSUED.._'-----t*.-----.-_--.-_'_------_-----. °,,'=-_-.--------.-------.'-- - <br /> AMermtiomm and/or rem*mmen4mtiono:------------------------------------------------------------------------.----....................................................................... <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------... ------------------------------------------------------------------------ '—'--'' <br /> ____________________________________________________________________________________________ <br /> ---'--'----''----'''--'----'---''---''--'''-----''''--'''--'-'---'--'---''-''---'-'-'--' <br /> FINAL INSPECTION BY:----------------- -------------- Date-''_'---.-_--'--''---'----'- <br /> SANJOAQU|NLOCALHEAOHDISTRICT <br /> 130 South American Street 3n0West Oak Street 124 Sycamore Strom o0uWest 9th Street <br /> ' <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 6w v nm.""" "°. c" "'°/ ="= <br />