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- * <br /> APPLICATION FOR SANITATION PERMIT Permit No . <br />/ x ' k�o�n�ta ;" <br />. ` --- ~~r--'-/ <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> CharacterThis application is made in compliance with County Ordinance No. 549. <br /> IF <br /> Installation will serve: Resiclence�Cf Apartment House [:] Commercial o urt Motel F] Other [_1 <br /> Water Supply: Public system E] Community system El Private 2-16,pth to Wafer Table*��f._ <br /> of _-. to - depth of - feet: _-_ Gravel E Sandy_ ` Loam '- Loam - ' -- -- -- . <br /> � <br /> Previous Application Made: Yes E] No �rNow Construction: Yes =�/O E] . Yes No [I ^ <br /> TYPE OPINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank 6 if public sqwer is availablewithin <br /> ' <br /> Septic Tank: Distance f i +ofri /40_!?r!�� Ki | <br /> ^� <br /> No. of compartments-------- ---- - ---Size_/ <br /> Field: Distance from <br /> Number of 'lines--------$ ----Length of each line -_vvmm of trench ' <br /> Typ� nf �|+e, �ut���L�g Depth of 6|hyr |ot | |engtx---..�����e--__- <br /> Snopuge Rt: D�st nce' to nearest wu|L--_-''--''Distonce from foundation--------------------Distance fv nearest lotkna------ <br /> [] Number ofpits----------------------Lining material-------------- --------Size: Diameter---------Depth-------------------------- _ <br /> Cmopoo|: Distance from U Distance from foundation-------------- ---- Lining material <br /> [] Size: Diameter Dept Liquid Caocity' /s. <br /> Privy: Distance from nearest w°L--._-_-----------.u/stano, from noo,o5f building-------------------- <br /> [J Distance fonearest lot <br />| ' � <br /> |�no--'''-'''--�''��-__-'--'-_'---'''_-_-''--_.''--'_-- <br /> Remo6eHng and'/or repairing tcleoribe)'--------------------- --------- --------------------------------------------------------------------- --------_.__._________�_-_'_~_ <br /> __-.___-_-____.__----------__.^_-.-__-�----___.---__-_--_.-_._-.__--_—_---_'_ <br /> ------------------------------------------- -­-'-------------------i---------------------------------------------------------------------------------------------------------- ------'''---'---''-----''---------'--- <br /> ------------------------''------'----'-----------------�------------------------------''-----'------------------------------------------------------------------------------'---------'��----------------------------- <br /> ~* <br /> hereby certify that I have prepared this application and that the work will be done in accordance with Sao ��m� � County / <br />| <br /> ordinances, State laws, and nJes and � of the SanJoaquin Local HaaKhD�t6o+ �( <br /> .^ -� <br /> Gigne6i_ --/ ----.--._---_-_-.. and/or <br /> By:---- ''-_-'---''-''-'---' <br /> (Plot plan. showing size nflotlocation ofsystem in,elationt* wells, buildkn-gs, mtw . can be placedon reve,semidmr --~--� ---� <br /> R,�PA�TN%-NT USE ONLY <br /> . . <br /> /\��L|C/�'|ON /\�C�P|�D U,'-.*��xx-*�~ .- ..-�.���.. DATE--- -��^�'��� --.--- � <br /> -,h-- <br /> REVIEWEDDY--------------------------------------------------- -------------------------------------------------------------------------. DATE--'--''--_-----.__------ . <br /> 8U|LD|NE) PERW[T |6SUED'-----'''--.-�-�'---'''-'''__.''----''---'''-- DATE-.'''-'''-'--'''-''-'--_--' <br />' <br /> Alterations mn6/n,recommendations:-------------------------------- ----------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------ '-------'-------------'-----------------''--''----''--'-------' <br /> _-_'---__-'--_'--''--''''-'_''----''�-'—_''''''-_—''''---'-''--'''_-''_-'_''-'-'-''----'-' �- <br /> _____________________________'_________________'___'__'______'____'__'- <br /> � --'---'--'-'''''''-''-'''''_-.' �' ''_-'-'--'�--''''-'''' ''_-- <br /> _ <br /> � ~�r�� <br /> �N/\L |N3P01 <br /> B�T[U� BY�''--' ��''-'--- Date'''-��.��-������.����-''''-'-''-_.- <br /> SANJOAQ0NLOCAL HEALTH DISTRICT <br /> � /»n Som* American Street sonwe* Oak stro°+ /ou Sycamore Stm** 8/4 w"*h ^o^ Street <br /> / <br /> Stockton, California Lodi, California ' Manteca, California Tracy, California <br /> ' ES--7- 2M nv.isoa 1-57 rpnz <br />