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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in <br /> Duplicate) Dofa Issued <br /> is hanabv made to the Sun Joaquin Local Hoo|t6 District for m permit to construct and install herein described.� <br /> Thisapplication iJ ; |i - <br /> JOB ADDRESS AND. �OCATIQ)V', <br /> -------------------------------------------------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court [-] Mote] L] Ofherjo <br /> Community system <br /> Number of living units: 11/-'Mumber of bedrooms J---- Number of baths Lot size -S-0- <br /> Wafer Supply: Public system -1 Private E] Depth to Wafer Table -------- ff. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel E] SAdy Loam �'-- Clay.Loam Ej Clay Adobe/Hardpan E] <br /> Previous Application Made: Yes [-] No IR/ New Construction: Yes ;/'No <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public <br /> Sc nk: Distance from nearest v,e|| — <br /> �� -"�' --'---'-~ �ror�foundation---- ','�'= ^mzm�� <br /> u� f -�. 2��� ���� <br /> ��--'/D|s | Field: Distance from nearest well-.-- Uisionc° frnm foun6u+ipn� ' -.Dis+on to + | || <br /> ------------ <br /> Length <br /> L�ngtk o ���� line Width c +rrn�D6 Number of lines---.- ' <br /> Tvue of filter mo+er�4Depthof filter ma+e6aL�_.X _-Jo+u| �vgt�_... <br /> Soapoge Pit-. D��nco to nearestw�L'''-�''-''D�tonca from foun6o�on__-'''-_D�+ np, h, noure` lot |�u. <br /> r_1 Number cJpi�---.__-Uning ma+^�mL_-- --------Size: Diomotac.___-_-Dvpth---------------------------------- <br /> Cesspool: <br /> ---' — <br /> Cv,q'oo : Distance from nvumetwcL'''---O�+onxefrom foun6nt�n'-_—'-��Lining mu+e,�L-'--'----- <br />' ---'�--r----�-- <br /> � <br /> [] Size: Diameter --_Dept ---.__-_--_-----_-�oui6 Copud+y-_-_-_-'.gals. <br /> Privy: Diduncefnom nean�+ wnU'--� ---'''---'''�-''D��nce from nearest building--------------------------------------- <br /> LJ D;�ancefo nvon,sf lot line.--- -----____________.._�______�_________.__--�__ <br /> Remo6e�y and/or repairing (6escrb���'''-_-''''�-_-.'-__''--____.---__-_-__-_____.._ <br /> ordinances, State laws, and rules a-A Ith District <br /> ---I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> `-------`'-----''--'----regulations of the San Joaquin Local Hea <br /> -----------'--`---'-----------------'--''--'----------�`���������'���'�����������'���'���'�����'�'-�����'��-����'������������������������' <br /> �--'--'-__.'__.''--_-''-_-''''-__-''-__-''-__-'''____.-._--_,�__.-__ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-_<2 <br /> DATE`E~E` ^" "'---------'— � '---- —--------- --------------------------------- <br /> ------------------ ----------------------------------- <br /> BUILDING PERMIT |S3UED-_---'. -_'--_--_---.''-___''---'''-___ � <br /> AKv,o+�n and/or ,ncommon6aMnns-----'�'-_—.-''--' <br /> - <br /> ---'' �.___. ------------------- <br /> --------------- <br /> -_--'-''--' '---''' '��''---''�-''--''''__''''-�, ''�-_''''--' ''- .. ' --_._.. <br /> --_-_.--__._----_-_-_--------_-----_.. —_--_ ---------------------------------------------------------__-__._ <br /> RN \L <br /> ` <br /> INSPECTION BY:------------------------------------------ Da+o.''''__-' <br /> ^ <br /> SANJOAQU|NLOCALH6ALTHDISTR|CJ <br /> /su South American Street 300 West Oak Street /32 Sycamore Street � mw North "C" Street \ ' <br /> omcu"". California Lodi, California Manteca, California Tracy, California <br />