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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued �Applica-�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work-herein d6scribed. This application is made in compglianc wltb County Ordinance No. 549. Owner's N 8 rip, --- - ---- ---- -- -- -------------------------- Phone------------------------- Address......? Installation will serve: Residence Apartment House Commercial E] , Trailer Court Motel Other,' Number of living unifs: ___/--- Number of bedrooms --- Number f baths ---I--- Lot size ------- X Water Supply: Public system Ej Community system El I ��Dpth t .Water Table -------- ft. Character of soil to a depth of 3 feet: Sand 0 Gravel El Sandy Loam ;,�Cplay Loam Clay [] Adobe Hardpan Previous Application Made: Yes E] No ER/ New Construction: Yes [Rr'r No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: v`" "ep'"" '""" or °°""p°°' p='""`'=° if -j Distance from xvu , °�.w~ - " " : . ". ��^ ~� v�" o� onm. V13 No.'ofcompurtmrn+` -----Size��)- N-- . Liqui6 . -� ---C*pucity----------------------- Disposal ---.----'D|spos | � F�\6� Distance from nearest U r ^ � � ' � = 1'�'^ Number o{ lines ~ Length of |�n� ' Vi6H` - '' ��. T � o�- � _Tvoe of filter moh,�oL�f.�Q �°D�o+ of ��*r mo|e� -.-'Totu| length --------- Seepage Pit Distance to nearest wnU----------------------Distance from foundation--------------------Distance to nearest lot |.me----------------- 11 '---_-11 Num6er of pDs'-''''-_'Lining material----------------------- D�mvter-'---'-'-Dopt�'-''_--''-''- ' �& : Distance from nearest well-----------------Distance from foundation--------------------Lining material -'''-''-'---'-- �m [] Size: [Xume+ec-.---------------------------------Depth----------------------------------------------------Liquid Cupux|hy----------------------------gals. Privy: Distance from nearest well-''-'''-''--''-'''--Distance from nearest building''-''''-_'------' [] Distance fo noono,t |o+ line----------------------------------------------- ----------------------------------------------------------------------------------- -�-- Rmmn6n|img and/or repairing (dezribo):--'--_''--'-'''-''-''_-.''-_---_.---_.-'--------'--__.-_.'_-'--'--. '--'---'-------'----'-------'-'--''------'---'-----'--------------'---------- ---'-'---'--'---'-----'--'''-------''---'--'--'--'---'------''---''--'--'--''--'--''-'--'---- ~ --._-.--'---'__-_---____---__~-__..__-_---.__.-__-._'-___-.__._--_____--___-- the work will be done in accordance re t ordinances, 5 141ay and rules Kd re ti6 f the San Joaquin Local Health District. (Plot pla show ng size of lot, location of system in r Alaflion Wells, buildings, etc., can be placed on reverse side). FOk 6E-P-A'RTMENT USE ONLY DU|LO|NG PERMIT ISSUED------------------------------.---------------------------------------------------------------------- DATE_-.-----_---�--_.--_. - Alte,ufionsun6/nr recommendations-----------------------------------------------------------_.'-__'__-_ ------------------------------------------------------------------ -'--'------'--------'----------------------------'------------'--'---' ------''-'''-''----''''--''''-'''-''''--''''--''---'----''--'-'---'--'''-''---'''---'------'----' -------------------------------------- — ------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------- ----_---_---__------_---__---___-----_______-----__��---__----___-----__-------_��_--_��--'_----- -__------_-----__-------__---_____-----_--------_�__------ FINAL INSPECTION BY�--./�~��.�~"�'-----------' Du+o'--.��-��-.-��'��-^----_---_- 105;;N +~ / SAN JOAQU|NLOCAL HEALTH DISTRICT /m South American Street 300Wes+ Oak Street /ss Sycamore Street mw Norih "C" Street St"ckto", California Lod;, California Manteca, California Tracy, California En_��~R",/=d vv-2/00