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u\ �` <br /> ~. �. APPLICATION FOR SANITATION PERMIT Permit No. <br /> � `\ ^ <br /> � (C �p�tm &n `� ' ' ' Du+n |ouoJ~ <br /> �__��/_/---_ <br /> b hona6v mu6o to the Sun Jo'aquin Local Health District for ape��mif toco ` cf und'in�faUfhe work 64r in | ��o6 <br /> Thisapplication is made in cJ� with County ,J - -~~ ' <br /> JOB ADDRESS AND LOCATION------ - ------ <br /> --------------- <br /> Installation will serve: Residence House Commercial E] Trailer,C urf E] Motel Ll Of her,E] <br /> Water Supply: Public system D,-,Commun'ity system E] Private E] Depth to Wafer i0lble ft. <br /> Character of soil to a depth-;f 3'fis�eif.-�Sa`�"d Ej Grgvel E].' Sa��y Loam E] C-lay Loam F-I Clay [] Adobe 8---Hrdpan E] <br /> Previous Application Made: Yes E] No EZ�1, New Consfrucfion.� Yes B' No [I FHANA: Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool-permiff6d if-'Piublic sewer is available 'Within 2( <br /> Disposal Field: Distance from nearesf�.welL_:...............Di tance from f8urdafion--------------------Distance to nearest lot line----------------- <br /> s 0 <br /> Seepage Pit. Distance to from foun�lafion---_--------4_�------ <br /> Ce ol: Disfance from ne�are'sf well-----------------Distance from foundafio <br /> xemoom/ny and <br /> /or repairing (describe'):--- -''-------------�--_-_----.'�-___-__�-��.-.-...-�-.---.___.-.-'_-__._- <br /> � <br /> ----'-------'---''-'-''-------'-r-------'-'--------------��-----------'-------------- <br /> _'---__.------.-_------'_`-`^''-----'---''-_''__---'-----_---_-_-_-..-----.__._'-_'-_-----._.--_--- ^ v <br /> --------------------------------------------------------------_.�_�-`-_-__-_-.,-_--_----_---__------'--_--.--------- <br /> / � <br /> ^ ~ <br /> ordinances, State law an,0 rul�s and 'regulations of the San Joaquin Local Health�'Disfrict <br /> (Signed)------ <br /> -�-� �c�. <br /> (Plot plan, <br /> howing <br /> � <br /> / <br /> - _ ' ' . ' \ <br /> ` - <br /> - �� <br /> �a� <br /> ---''' <br /> size of Hot, location of system in reb4io;�f6 buildings, efc., can be placed on reverse side). <br /> � ''----'---__.'-'. _-- - and/orrecommendations:---'----'---------''r '~" -» *�'�^� � -''�0^ � -/_---.----_----_.-___ <br /> ._-_-------__-__- ----------- ------------------------------------------------------------ --__-..__-_---_. <br /> _''-----'''''_'----''' - -'_-'-''--''''_''---'—_'''-''---�'�' '''--_''''---''''-'--.------------------------- <br /> ----- -------------------------------------------- <br /> -'--''---.---_—_--_-----. ----._--. _--------.---_'_----._-.-'----_--._._.—.. <br /> FIN \L <br /> |N�PB�TK]N QY .�/L� Do+*...... <br /> _ .� �=-.._---..�� <br /> ~° -.—� --- - ---_--_-_' <br />� SANJOAQ0N LOCAL HEALTH DISTRICT <br /> /30 South American Street 300 West Oak Street or Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California rmov. California <br /> ES-9-2M Re°is°ci 1'57 p.rzo <br /> � <br />