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� <br /> / �� <br /> APPLICATION FOR SANITATION PERMIT Permit � <br /> � � <br /> (Complete � O�pU*efe <br /> �,� ^~ ' <br /> l/ � -Date |vnuo6 .��,'�J�.67.�~' <br /> / � <br /> Application is ho,m6y made to the Son Joaquin Local Health District for u permit to construct and in'fa|| +hewn�k herein described. <br /> This application i 6 i |i with County Q)Ldinance No. 549. <br />� --- . _~.,^.~ AND " <br /> ' Addre,s------------------ -g <br /> Contractor's Num ^u�-1---- <br /> - -�-� . ---- -_----. rnome..�c-'^c'er�c^c ------- <br /> Installation will se6,e; Residence Apartment House 0 Commercial E] Trailer Court Ll Motel El Other <br />' - <br /> Number of living units. umber of bedrooms 0 Number of baths /.- Lot size <br /> Water Supply; Public system E] Community system E] Private � Depth to Wafer Ta6|o ' ~ ft, <br /> Character of soil to m depth of 3 feet: Sand El Gravel E] Sandy Loam 11 Clay Loam 0 {lay F-1Adobe 'K Hardpan Ej ' <br />| Application Made: Yes [] No Y —w Construction.-- '`~ Ej No <br /> TYPE OF 'INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well----------------L-Disfance from foundation-------------------Material <br /> Disposal Field: DisMnce from nearest well- -----Distance from foundation---1.0---------Distance to nearest lot Iine.;Xa_'­ <br /> Type of filter <br />� ��°- . --__---- - - .~... length------- <br /> Seepage n/ Distance to nearest wa/ Uisfafrorn foundation <br /> ---------------- <br /> u/stancv to nearest lo* line' <br />. � ''—''----'''--�'---~-- -----,-'--'--''--''--'_---'-'�' ) <br />/ <br /> Remodeling um6/o, A ' iring /����6r4�-- ------------~/~ . ^�K <br /> �--- _-___''--__-__-___----_--__.-_~_'''__.''---_'--'___.'__----_---_-___'__.'_--. <br /> ._.___-___----------------.-_---------_-----------_..---_----.-...---------------.----_---------.-_.--' <br /> .---_..__--__-_--_-__---'-_.__-____-_-_-__-__-..___.-_-_--.-----__�-- <br /> ' <br /> I hereby cer4lht that I have prepared this application and A <br /> at the work will be done in <br /> .� <br /> ith <br /> oaujn <br /> ocal <br /> Health District. <br /> ordinances, . � �-'Wnierpnlwne�� � . <br /> ~ --------------- --'��fp�n. sowing s^e of �f location of system in relation +o - . buildings, oan be <br /> FOR DEPARTMENT US-E ONLY <br /> pu+e,u+onsaod/or ,ecpmmen6a+�n,�--_----_-._------ ----__-__ --'-_--_----_-_- - ---�_--_ ' <br /> -'---'---�-''''-----'''--''---'--.�---�—_-'''-_�—__.''-.-'''--__.'.-_-'''__--'__.'-__.-_-_.___- <br /> ..__.__.__-.__-._'_--_-'_-_--_---_---------------._--_..`__-_'-__---__-___-___- <br /> -'__-''---__.'-'-_-'�'_-'''-''-''''----'-_'''-_'---.-'�'----'''----'�----'''_-_--''-''---'_---'-- <br /> ---_-�-'_-_—_--'_-___--_-_---.---.-------.-_---_-------.---'_._--____-- <br /> �N/\L INSPECTION BY�'-----'- '--. Do+a-� ------------------------------------------------- <br /> SAN <br /> '--_-__'--_______--_ <br /> / <br /> SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> /30 South American Street 300 Wesf"Oakstreet /32 Sycamore Street ow worth "C' street <br /> Stockton' California Lodi, California Manteca, California Tracy, California ` <br /> e;-9-2w o's| x°visv6 vv'2100 <br />