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\e| ������ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ----- <br /> (Complete <br /> ^ 0n *~ <br /> r~��'~ =��� � <br /> � v Dufo |,maed '-�/-Applica4ion is hereby - <br /> � 'Made <br /> San Joaqui� Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> Contractor's Name----- <br /> Installation will serve: Residence KL.Apartme'nt House Commercial Trailer Court 0 Motel 0 Other D <br /> Number of living units:/------- Number of bedrooms _2?—_ NU'mber of baths Lot size ------4..g <br />� Supply:' Public_ system, _ Rk ___..,,, ,/~~.. [j Private D D=ern to vvan=r /uo/e �ow��ft.'Prrev;ous Alpplic 'on Yes !:New Construction: Yes X[ No D <br /> / <br /> Character of so�il to a dep h of 3 feet: Sand E] Gravel El Sandy Loam F] Clay Loam 0 Clay [] Adobe Hardpan <br />| � No <br /> iTj <br /> (No se ic tank or cesspool permitted if'public sewer is availa6le within 200 feet.) <br /> Septic Tank: D;stance from nearest well'�A <br /> Disposal Field: Distance from nearest well_':�IW&-A <br /> A21sfance from foundation----ZA-t---..,-Distance to nearest lot Ii '57 <br /> Type of filter material----I-A-----5RDepth of fi�fer material <br />/ ~ length Total ''-.~_~='-_''-----' <br /> Seepage Pit: Distance' toon, ' <br /> materia � <br /> --------------------Distance <br /> -^h-D—oo+'�`-'' '~ '^'~ <br /> N6m6ar of p�, ,°_--__UUn�g <br /> Diameter.---- <br /> Ceopoo|: <br /> _.—. <br /> Distance from ne' un,sfweU."--------- --Distancafrom <br /> ._.� <br /> / <br /> —�~--'--'-. fpun6ut��n`---� <br /> -----�Uni. <br /> �ng--'_m-'o-'+-.p-�'-o'L <br /> Capacity-.--. <br /> _- <br /> --`-----'L ---.--� _--- ---_.__''-'—'---'-'Uou�6 Cupuc�v' ------------------------- <br /> Privy- D|,h�by from �ean,,+ m°� -''Distance fnnm nearest building----------------------- _ <br /> _LDi�unce'to nearest �f |in�-_.__.__`____..-.__--_._____..____�_________ _ � � � ' <br /> Rnmod�lng and/or repairing (describe): '--''_'--''-_.'-__'__.--'_ -------- <br /> --------------------- <br /> . _ <br /> ordinances, Stat S, and rules and regulaiions of the San Joaquin Local Health District. <br /> (Plot plan, showin size of lot, locafio�n of system in relation to wells, buildings, etc., can be placed an reverse Alterations and/or recornmend tio s-------- ---- <br /> --_.______-_--.__..��_-.. � -_-_�_----._--'-_____S------- ------------------ <br /> _'-' �-','----_.'_� ''-� ---. <br /> -_-'-'_--'-'-'-''-__----_- -_----_-..___-__.-__-.__.___'---_--___- ^ ------'- --- - ' - <br /> \ <br /> �. <br /> `_'-''-''_-'_-''_-_______ _`____��_____,______________�_______ <br /> FOR DEPARTMENT USE ONLY <br /> --------------- <br /> nc,/c, o/ BY -"�.�u'n � rcnm// /��u�u. I ------------------------- <br /> SAN <br /> -------- <br /> SAN LOCAL HEALTH DISTRICT <br /> /»u South American Street »oomw� Oak Street /ao Sycamore Street 814 North "C" ��=° <br /> Stockton, California Lodi, California maowm°. CoSf*,o|m Tracy. California | <br /> ` <br /> ""-°-"m ~"°^°'°== 12-S4 Y <br />