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APPLICATION FOR SANITATION PERMIT <br />K <br />(Complete in Duplicate) <br />~ ' <br />�~~ � <br />PermitNo.����-..Date <br />����_ <br />' is hereby made to the San 'to construct and install the work herein described. <br />Thisupplication ismade incompliance with County Cirdin No. 549. <br />J(]D ADDRESS AND _�4�5�// y v� <br />-------------'---'-'' <br />uwN----.----�------._-.--'--Phnno_ <br />- Number of ------------ <br />Installation will serve: ResidenceW/ Apartment House F] Commercial E] Trailer Court E] Motel 0 Other E] <br />of |iving units: ..)-- Number of bedrooms Number of baths _ ' ��' Lot size .. <br />-----------_--- <br />, ����: Public system Community system[] Private Depth to Wafer Ta6|o <br />Character mfsoil +oadepth of3feet: Sand E] Gravel E] Sandy Loam [l Clay Loam [] Clay [-] /\6o6ep, Hu,6pun[] <br />Previous Application Made: Yo, [] N"n�� Na�(�nn,�ruc+;on� Y��1�'No [� <br />'�� ��� <br />TYPE OF INSTALLATION AND SPECIFICATIONS - <br />(No septic tank or cesspool permitted ifpublic sewer Ysavailable within 200 feet.) <br />3 Distance from nearest well ----------------- Distance from foundation -------------------- Material ---------.-_____ <br />No. of compartments -------------------------- Size -------------------------------- Liquid 6op+6---------- ------------- 'Cupaci+y.--.-----. <br />' Di' | ie|6/ Distance from nearest well - - ---'Distano, from foundation -------------------- Distance to nearest'lot line -.--_._ <br />Number of lines ----------------------------------- Length of each line '—''-'''--'_Width oftrench '-_-''-_''-'--- <br />4~~w~ - Type of filter mofa,ioL---------Depfh of filter material ---- ----------------- Total length ------------------------------------------ <br />Suupo <br />/Pi Distance to nearest�� ^�* ' ' <br />Number of pifs-.Jo-----Lining m 71 --- <br />Diameter --7'" ------------- Dep+h. -'.- <br />Distance from nearest weU------Di�nnce from foun6o+�on-----__Lining m*toriuL-------_.�- <br />Privy: Distance from nearest well ''—''--''-'��'-'''--Distance from nearest building '---_--'--'______ <br />El Distance 6nnearest lot lire `-------------------- ---' <br />Rem/od .1in I and/or repa' '.n � d cribe): ------ ----- <br />------------ <br />I hereby certify fha+ I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, laws, and, rules and, -re <br />gulations of the San Joaquin Local Health District. <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be <br />placed on reverse sWie). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION <br />REY|E\wB} <br />DU|LD|NG PERMIT ISSUED -------------- ---.-- <br />------_--'-.-_---------'--- DATE --------------------- <br />---'' <br />A - ------ --------------------- - ----------------- ----------------- <br />°-`) <br />SANJOAQV|NLOCAL HEALTH DISTRICT <br />130 South 4m*rio"" Street snnWest Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockfon, California Lodi, California Manteca, California Tracy, California <br />