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APPLICATION FOR SANITATION PERMIT Pmnn ,31_ � <br /> x \o^ <br /> (^�Cm^�m~p�iwfwinafDuplicate) C9 Li/ 3 re Date Issued -/rS-- <br /> go|icut[un i, hen,6v mo6n to the Son Joaquin Local Health District for u permit to construct and install the work herein 6ssv,i6o6.application <br /> is madein compliancewith County <br /> JOB ADDRESS AND L CATI <br /> (2 -----77 ----- �2 <br /> Installation will serve: Residence Apartment House Commercial Trailer Court E] Motel qth2.�00 <br /> Number ofliving units: ^~ Number ofbedrooms �4 Number ofbaths /.. Lot size — ------- ~ <br /> VV�e �o�v Public system [l Community system [I ��o Depth to Wafer ft <br /> Character of soil to a 6emth of feet: Sand [] Gravel E] Sandy Loam E] Clay Loam [] Cloy [] Adob Hardpan [] <br /> P"uv;muo Application Made: Ye, [] Nev Construction. Yes [-] N0 V » <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sepHctank or cesspool pormHfmJ if public sewer isavailable within 200 feet.) ' <br /> | <br /> Septic Tank: Distance from nearest well------ from fnundutino--_----Material -------------_ / <br /> No. of compartments------ --------------------Size--------------------------------Liquid depth--------------- ---------Capacity--------------- - <br /> Disposal Fiel Distance from nearest well-----------------Distance from foundation--------------------Distance tonearest lot line'-- <br /> Num6e, of lines-----------------------------------Length of each line--------------------------- <br /> ofhnnc6------- <br /> Tvpeoff�e, mofor�L''—�'�-��—Dep+' of filter material---._---Totu. length ----_—.---^ <br /> �V <br /> le <br /> _~ '+ <br /> ypa eP�� D�f ncn nearest ]of |ino`_�� ` <br /> Number ofpi�_��_- Lining D�mo�c'��� — Deo�. <br /> wr -- ---� --`�,---' �~^�'---' ' —°~�'~---''- <br /> �esp" � Distance from nearest well-----------------Distance from foundation--------------------Lining moforiaL--''—'---'—'� <br /> [] Size: Diameter--------------------- ----------------------------------------------------Liquid Capacity, --------------------------gc ]` <br /> Privy: D�st nnu from nearest well '''--''''—''_'''—'—Distance from nearest building''—'�'—'--_---._''' �� ^ <br /> [] Distanoa to nearest �ot |i --.---____.._'-__--_-_--__----__----- <br /> Rempd��g and/or repairing (6anzibr �''' ------------------------------------------------------------ ------------------------------- <br /> --'—__—''—'_--'—'-'''—'---'_—'—_ ----------------------------------------------------------------------- -------------------------------------- -------------------- <br /> ---------------------------------------------- --___--_-____—..___—__—..___-___..__-'---_--._—_-____—__--- <br /> _'---'--'--__---__..____-__'_—__-___...___--__.-__-___—.___—__---.—__'_-------_� <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun. <br /> ordinances Stafjell wt-, and®rlo ed regulationi 666 +h e San Joaquin Local Heal+h District. <br /> an of s em in relation to wells, buildings, etc., can be pi e. <br /> (Plot plan, showing size of let, locafl' ;C��_edon reverse S;8-")-- <br /> �911,9E�ARTMENT USE ONLY <br /> Of 4 <br /> -?---------- ------------ ----------------------------------------------- DATE----------------------------------------------------------- <br /> -° <br /> '---'--'—'—''''—''''-''--'''--'—'''--''---'—'--''-'---'-'''--''--'--'''--'''---'---'------'--'- <br /> -------------'------------------------'���������------------'-------------------------'��---'-----------------------------------'����--------'------------''------------------­­ <br /> ______'__________________________________________________'_________________________�_____________ <br /> _---''--''_—'''—''--'''' '''�--_'''--'''''--'''''--'''------'''--'---'_'—'--_--'--''' <br /> RN/\L INSPECTION 8Y�—..1��— '*��' - Date----------- <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> . oo svum American Street 30D West Oak Street oz Sycamore y+rew+ ow w"*h "C" Street <br /> a*"uo". California Lodi, California Manteca. California n""r, California <br /> cs--9-2w /0'52 ne./mJ v/'e/uo <br />