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' <br /> APPLICATION FOR SANITATION PERMIT Permit No.,_I- ,3 <br /> (Complete in Duplicate) Date <br /> plica-lion is hereby made to the San Joaquin Local Health District for a permit to construc I ork herein described. <br /> 'Cal 'ON PERMIT Permit I <br /> e' Date 15s <br /> f r p mif 0 co i y <br /> """ application " " a"" "' compliance <br />| '~~ ~'^-t�~��~--' ~t�r-�--- <br />` Conhocturs Name----------------------------- .. -_----.—.. P�one �� ~ <br /> � --artment House '� . <br /> 7stallation will serve: Residence 1 Trailer E] -Motel E] Other E <br /> i Number of Ii vinq units: ',�. Number o| bedrooms ,2�. Number of baths _/-' Lot size '- -------------------- <br /> Water <br /> --'__-'_Water Supply: Public system [I `Community system E] Private Depth to Wafer Table a. ft. <br /> Characterofsoil too depth �� SandE] Gravel [] � 'y ' m � Cloy LoamK Clay E] Adobe El Hardpan [] <br /> Previous Application' K4o6n: Yr, E]Y No]�� New Construction: ^��ucf�on� Ye, �� [ <br /> No� /.�� <br />' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> /No septic tank or cesspool p,ermitted R public sewer isavailable within 200 feet.) - � - <br />> 'Distance from nlen,o,t well-----------------Distance from foundation----------------- -Material --------------.-- <br />/ <br /> No. vf �ompo��en*^--------_--.-S��'_-_--__Uqvkj 6epfk-._---'--C*pudfy--.----.. <br /> | � � <br /> Distance- from U Didnnon6nm <br /> foundation ----- <br /> Numberof lines' --/ Length of each line� -geof trench ~.e� <br /> ^ ---._- <br />/ <br /> Type c� filter m�h,r|u| -'Ouot of ���r mote�oL'��L.��--'Tntu length-_—����---__------- i. <br />' <br /> Seepage Pit: Distance t, nearest waL'''----''Distunco from foundation--------------------Distance fo nearest lot line----------------- <br /> Number <br /> _-_--Num6er of "it"]--------------------Lining material _ ----------------Size: Diameter------------------ ----beofk---------- ---------------------- <br /> Cesspool: Distance from nearest well .---.-Distance from foundation--------------------Lining material ------.—'_- <br /> �e^D�me+oc�-..,�-*=��r_-'',Uopt --_'''-�.-__-.-=''.--L�u�_��pu��� |� <br /> r <br /> Privy- Distance from xt well------------------------------------ -Distance from nearesfbuilding <br /> ing and/or repairing (descri <br /> --------------------------------X ----------- <br /> ^ ' <br /> -__.��.`� _----_---------_-.---.---.--_.___._-_-..__------.----.----.---_.--' <br /> '--'-----'----------------------------'—''------'''------'--''-----------'---'----' <br /> � ' ,*dthio application and.thaf the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, andl rulp tin I d regulations of the San Joaquin Local Health District. <br /> / <br /> .,pr �ontractor) <br /> (plot plan, showin'gsize of lot. location of system in relatidnr to Wells, buildings, efc., can be­pi7_ ed on reverse7side)e' <br /> Of <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------------- <br /> Alterations " ~v= 'e`"m °=d"'"~' -------- ---------- ------ --------- '�'�- ------------------------------------ -------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------- '----'-_-_---_--_-_-_.-_---_-____--___--_- <br /> . ----''-''---''--''--''-'''-'''—'''-'--'^--''-- --''-'-'-''''-''--' <br /> ''--''--'----''---''''---''-' <br /> ---------------- <br /> ---------------------------- -----------_-------_____---__�____---___----___---___---_--_---------_-----__---_-----__---_----------___-----____-----'---__---_--_---_----------_ <br /> '---'-''-''--'''-'- --------- ''-''''-'''-'--'-',--'''-'''''—''-----'''----'- <br /> ----- <br /> FINAL INSPECTION' <br /> BY:--------------- <br /> Dofn---.. ~~ �� <br /> 7�1- -----------'_--_-. <br /> SAN <br /> JOAJU|NLOCAL HEALTH DISTRICT <br /> mo s""fh American :areef 000 West Oak em"+ oz $'"^mow sv=.* 814 w=+h ^c,' St=° <br /> . . <br /> � Sto*kt="' Ca|iforn/° Lodi, California wa"w=. Cakfomia Tr°cy. cakfo,m° <br /> � <br /> Revised W-2100 <br />