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_ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ..��I------------ <br /> (Complete in Duplicate) Date Issued <br /> Applical-ion is hereby made to the San Joaquin Local Health District for a permitfoconstruct and installfhe work herein described. <br /> This application is made in compliance with County Ordinance No. 549. Lf q F_ A49 <br /> Installation will serve: Residence [2�_Apartment ouse E] Comme *ial E] Trailer Court [3 Motel [-] Other El <br /> Number of living units: --/---- Number of bedrooms .__--0-Number of baths _1... Lot size -_------------------ <br /> Water Supply: Public system El Community system El -Private Ig- Depth to Water Table,:��Z ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El., Sandy Loam E] Clay Loam [-] Clay [-] Adobe gL_ Hardpan 0 <br /> Previous Application K4a6o: Yeo [] No [R Now Construction: Yes 0 No H8 <br /> TYPE OF INSTALLATION AND SPEC|F|C/\T\ONS: <br /> (No septic tank or cesspool permiffe6 if public sewer isavailable within 200 feet.) <br /> Septic T ` am f nearest well-----------------Distance from foundation------------ ------Material -.--------------- �u <br /> [] ....... ------------- ---Size--------------------------------Liquid depth Capacity--------------------- <br /> Disposal Field: Di�n*~ from nearest wrU ^��� .. ' \`� <br /> cWidth of <br /> .. �� Number of lines �� Length of each |i <br /> Type of filter muto�oLJp -� J�LDeot� of filter material length -. � _---___.- <br /> 3eepugo <br /> Pit Distance to nearest woL---_---Distanco from foundation------------ -------Distance to nearest lot line.—_-' <br /> [] Number of pits--------Lining material — ----------------Size: Diamefoc--------�Depth--------------------------------- <br /> Cesspool: Distance from nearestwuU---.--Distance from foundation ----'-�n� �L��-'-''-''-'- <br /> Lining material r <br /> Size: Diameter --------'_.-�-Dap�------.----------.L�uid Capacity---------------------------- <br /> ~, <br /> Privy Distonce from nearest well.------------------------—''-'''-''Distance from nearest building------------------------------------------ K <br /> [1 Distance to nearest �of line------------------------------------------------------------------------- ---------------------------------------------------------- _ <br /> Rnmndeling and/or repairing (describe):-------------------------------------- -'__.---_.-''-__-_'-'______________.______._____------------------------------------- <br /> I hereby certify <br /> that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. Sta"s, and rules and regulations of the San Joaquin Local Health District. <br /> --------------- <br /> , ~' plan, showing— --- of lo+—' location-- of system - ' � <br /> FOR DEPARTMENT USE ONLY <br /> \xx <br /> -'-'--'---''--'---'-''''---''''--'''--'''--'''--'-'''-'''''-'''---''''-''--''''---'--'-'-''--'' <br /> -'-''-''-'-''-''--'---''-'-''---'---'''---'-''''--'''--''--'''—'''-''''--'-'-'---'----' <br /> HN/\L INSPECTION BY----------------------------------------------------------------- Du+e--��-'�� ���--^ -----._-.- <br /> SAN JOAQU\N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street /32 Sycamore Street 814 North "C" Street <br /> e"=kt"". California Lodi, California Maoteou, California Tracy. California <br /> ""-°_,= =°^^`°""" ``.. <br />