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APPLICATION FOR SANITATION PERMIT Permit No. <br /> `--`'-- in Duplicate) Dufo IssuedApplica+ion is hereby made to <br /> � <br /> the San Joaquin Local HealthDistrict for upermit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> (11 <br /> ------------------------------------- <br /> ---------------------- <br /> --------------- <br /> Installation will serve: Residence El Apartment House Ej CommerciTU?"frailer Court El Motel 0 Other C] <br /> Number of living units: -------- Number of bedrooms -------- Number of baths --t- Lot size ----- ------ <br /> Water Supply: Public system El Community system El Private Ej Depth to Water Tablet--Z ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam��,-<Iay Loam Ej Clay E] Adobe E] Hardpan <br /> Previous Application Made: Yes F] No E] New Construction: Yes 0, No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu6lic sewer is availa6le within 200 feet.) <br /> Disposal Field-. Distance from nearest well--t;-d-'+--Disfance from foundafion--Ae)-----------Distance to nearest lot lige------------------ <br /> Seepage P;t: Distance fo nearest well----- - -------- ----Distance from foundation-----­---­------Distance to nearest lot line------------ <br /> El Number ofpits Lining mute6o| Size: Diameter- Dept <br /> Ces,puo|: Distance from nearest well-------------- .Distance from foundation----. motorioL--------.--.. <br /> F1 Size: Diameter------------Depth----------------------------------------------------Liquid Capacity- ------------------------go|,.4 <br /> Privy: Distance from nearest we|L''-''--''-'''_''_.Distance from nearest building�-'''-''-'__.____ <br /> El Distance tnnearest lot line ----- -------------- ----------- -------- --- '--_.-__ ------------------------------------------------------------' r� <br /> ��� <br /> Remodeling and/or repairing (6e,c,i6�L�n,- --7-011 -��4.-���v-,�x�`--'���������- -----_------ <br /> -----------------------'' -----------------------------------------'------------------ ------------------------------------------------------------------------------------------------------------------ <br /> -'-'-'-'--'---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---_----'_-.--_--._._-_-----___.---__-'_--_._-__-.--._--__--.--_-----. <br /> I here6y certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County <br /> ordinances, Sfafe ws. and rules and trequLations Abe SS-an Joa in Local Health District. <br /> (Plot plan, s owing size of lot, location o� system in relation to wells, 60dings, etc., can 6e placed on reverse side). <br /> BU|LD|NGPERW|T |SSUED.-_'-'-''_--''--'-'''_''----''''-'''-'''-'- DATE'-''--.'--_.-'--''_______ <br /> Altw,a+ionsand/ornecmmm*ndatiomo------------------._---_--_'_--___----_---_--.______ <br /> '''-''-''-----'--''--'''-''''-'''--''-''''-'------'---'--'''--'''--'---'---'''-----'--'--'--'- <br /> ____________________________-___________________'________________________________________ <br /> ----`-------`---`---``---``-------`-------```-------`---```-------`�----`-------`-------```-------``-----`----`--``` ---------------------------------------------------- <br /> _� - _-------- --------------------------------- ------------ ------------------- --------------------- _�____________ <br /> HNAL INSPECTION 8Y:- -'------- ----' Do+o- � r <br /> ------'------'--- <br /> SANJOAQU|NLOCALHEALTHD|GTR1CT <br /> /30 South Anneri"" Streof 300 West Oak Street /32 Sycamore Street 8/4 North "C" Street <br /> Stockton, California Lodi, California Manteca, California r="v. o*/a"rnila <br /> "°_*_"M `^"^46^,~""" 12,^ <br />