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' <br /> APPLICATION FOR SANITATION PERMIT Permit No <br /> 1«\\ �� ' | �m <br /> ~ \ ^ (Complete Duplicate) Date Issued -' <br /> T�plication is hereby made to the San <br /> 's application is made in compliance with County Ordinance No. 549. <br /> Installation will serve: Residence Apartment House E] Commercial F] Trailer Court Motel 0 Other E] <br /> Number of living units. --I----- Number of bedrooms of baths I----- Lot size ----*7_�' . <br /> Water Supply: Public -system 9( ct4o mmunity system [] Private E] Depth to Water Table 3X-'ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam Clay Loam E] Clay E] AdobeZ Hardpan El <br /> Previous Application Made: Yes [] K . <br /> INO New Construction: Yes 0 NoV FHA/\/A: Yes No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool peRrmitted if public sewer is available within 200 fee+.) <br /> eptic IV�4k) D�stance from nearest well----------------Distance 1r"orn foundation--------------------Material <br /> I : F . I k <br /> Diripojp�..' til Distance from nearest' � -'�----~~-.--�- from foundation— ^ ~ ~---~','"'~° '" "°�= ."' xnu`..,�-�.._ <br /> Number of ||my��--.' LengH� each line` ' VV|clt6 of trench <br /> SeeZpp?,,qe Pit: D�sfance to nearest -ell------*--------------Distance M_ <br /> foundation---- <br /> Distan�e to nearest lot <br /> Number of p��../-1-----Lining mo1e6uL. D�mmetec.-��� --- �^ '�-'- <br /> Pool:Ce D�+ ncv from nearest we�'-,--_D�f nce from foundation� -------------- -----Lining material------------------------------------- <br /> El <br /> ' ' <br /> E] ' S�o: D�mefer�-�--'---''--��—Dept _''''��-'''~�'''--.-�-Uoui� '�upoc�/ -'-''-'--'ou� <br /> U / ' ' ' -------- ' - <br /> Privy: Distance from nearest w°K'_'--���-�'''-''----------Distance-from nearest 6 4|Jing----------------------------------------- <br /> Distance to <br /> ��--'''-'-___''—D|stancoto na*n:W|of'|ine----------------- � <br /> 1 Remodeling and/or repairing /6anz�e :'' _ __/ux�x�x/c'~�7-_��` <br /> _. 1 `-- - -- <br /> _________________-� ---_-~_-_T_ <br /> -- <br /> . . __,���-c-�-.-__-,__._______�_--______-__.___--_______ � <br /> -------------------------------------------------------- ------ -------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I <br /> - - <br /> '---�'h " nm] this <br /> ounty <br /> ordinances, State laws, and rules and 1.regulations of the San Joaquin Local Health District. <br /> tq 1 ­2 __ 11 -1 <br /> (Signed)----------7--i -.1-A - Icsf__ .. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 4 FOR DEPARTMENT USE ONLY <br /> ---------------------------- <br /> FINAL INSPECTION BY:---, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Arnerican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca. California Tracy. California <br /> cS-9-2M ' «°"is°a 1'57 pp.Co <br />