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APPLICATION FOR SANITATION PERMIT Permit No. <br />k�oma�+��n <br />`---- Duplicate)— <br />Date |ouo6 '� U <br />Application is hereby made to the San Joaquin Local Health Disfrict for a perm'�f to corjsfrL4cf a.n.d install the work h6tein described. <br />This application is made in compliance with County Ordinance No. 549. W <br />Contractor's Name -4v t&tl f6V <br />Installation will serve: Residence 5a"oApartmerif House Commercial El Trailer Court [:] Motel El. Othej [:1 <br />Water u7p]�- —Pubric sysfem E:1 'E`=mmur�ity system [:] Private &� Depth to Water Table -------- ft. <br />Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam Clay Loam lay E] A <br />Previous Application Made: Yes Ej No [RIO" New Construction: Yes eNo E] FHA/VA: Yes E] No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: 41 1 IL <br />(No septic tank or'cesspool permitted if public sewer is available within 200 feet <br />Disposal Field: Distance from nearest welIZOO ----- Distance from founcl'afion/0��Disfance to nearest lot line <br />of fili <br />Seepa5e Pit: Distance fo nearest W6114� Disfanche'-from jou.-n-d'ationg --- to nelaresf lot line <br />Remodprinc <br />� <br />_-''-----'-_-'-___.'--'-__-^--__.--__-''-__--'_______..__-_._----._.—._._.__.._-------_----. . <br />��-��-'-------��---�-''--''----'-'------'-'---'------''''---'''--�'----''---''-''-'-'--'- �m <br />hereby certify that I have prepared this application and fhat.the workwillx� <br />ordinances, S!ate laws, and rules and regulations of the San Joaquin Local Health District.' ' ' <br />(Signed) -------_-'-_----_---.]Cxvneran6/n, Contractor) <br />0y-------- __..____--___-.__-.__---'_._---------_-.- (Title) ------------------------------------------- -_------___- ' <br />(Plot plan, showing size of lot, location of system in relation toWells, buildings, etc., can be placed on reverse side). <br />, <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED --------------- ----------------------------------------------------------------- <br />REV|E\�B} DY-''''-_�-_''-'��J.--'-'''_-'-'-_'--'—''''-_-'''-'-'- DATE --- <br />BUILDING PERMIT ISSUED -------------------------------------------------------------- �--------------------------------------- DATE-' -----_---______ <br />___________________�_�________________________________________________________________________ <br />- q--/157 - ---------------- --------------------- Date --------- ------------------------------------ <br />SANJOAQUQNLOCALHGALTHD|STRICJ <br />/30 South America"Street 300 West Oak Street 132 Sycamore Street m^North 'cStreet <br />Stockton. California Lodi, California Manteca, California Tracy, California <br />ES -9-2M Reviseci 1.57 F.P,CO- <br />