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tl/ APPLICATION FOR SANITATION PERMIT Permit No. . �'7 � 2- '' `~~ r~'~ in Duplicate)^ Date |so»y6 --------- -- Applica+ion is hereby made to the San Joaquin Local Health District for u permit to construct and install the work herein described. This application is-made in compliance with County Ordinance JOB ADDRESS AND LOC,�;ION.. ------------ ........ztpd�_ �--------------- ------------- --------------_ Installation will serve: Residence 26-'-A'partment House [:] Commercial E] Trailer Court [] Motel E] Other E] Number of living units: _/--- Number of bedrooms Number of baths __/__ Lot size -------- -------------- Wafer Supply; Public system 2--lCommunity system El Private E] Depth to Water Table 4�!_ ft. Character of soil tomdepth of 3 feet: Sand Grave| E] Sandy Loam L] Clay Loam E] ClayEj Adobe a- HardpanF] Previous Application Made: Yeo El NnE]~ Ne* Constmcf|on: Yes E] No �}�~' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) k Distance from nearest well------------------Distance from foundation------------------- Material --------- ------------------ AptNo. of oomporhnanu--------..Sio�._--_-_----Uquid 6opfh._--._---Cmpu:ity_--.—__- ~ Dispolal rield: Distance from nooro` weL---'-Distuncofnom foundation'--'''_'Distance to nearest lot line-'_-'--- Num6p, of lines----------- ------- -------------Length of each |ine_------,---VV�t o{ �onc6---------._-. `�'~-"~, Type off�nr moh,�mL'''—_-' Depthof filter material------------------------ length------------------------------------------ Seepage � Distance to rest �� / D| ton��t � line-AL.1 Number ofpits----/'''—'-Lining mu+oriu 'Size: Diumo|oc .....Depth '9/r-^ -_'-''- C000,00 - Distance from nearest wvU_-------------Distance from foundation------------------- Lining material ----------- [] S�ze: Diameter -''''--''--'—Dep+ ------- ''�'-_.'''—------------------Liquid Capacity-----'''--''-'gals. Privy` Distance from nearest welL--''''---�'--�-�-� Distunoe from nearest building.'-'--_''--------'- ^�Y 11 Distance to nauny,f lot line----------------------------- --._---__---_-_----_.—._._---_--__- Rvmu6eling and/or repairing (describe):--'---_'''-'''-'--_''-_.-'''-_.'-__-''_--_.''-'___.'-_.___-___- -------'---'-----'--'--'--------'-----------'-----'----'----'------'---'----' -------------------------- ---------------------------------------------------------------------------------------------- -...... ........'---------------------------------------------------------------------------- -------------------------------- ----------------- ----------------------------------------------------------------------------------------------------------------------------------''--''-''''--'''- I hereby ce i fha+ I have prepared this application and that the work will be done in accordance with San Joaquin County V7,001 a ordinances, St -a la s. and rules and regulations of the San Joaquin Local Health District. r--------------------------------------- 4�rt,�e rse side). (Plot plan. showing size of lot, location of. system in rel on to w6lilis, buildings, efc., can be placed on rave - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ~� ------- --�-'_--------------.. �� -- . ' '------- -----------'----------�'[ ------'----------------'-----------' .----'--''''--'�-'''��-'''-'''------��.~ '-_'---'''''-'-----'''-''''----'-''-'''-''-'-_. / / ( ��- _{� �� RN/\L |NSPECT<]N BY�-.. -_--.---- Dm+e-��1-.�.-l--��.�k��-----------� SANJOAQ0NLOC4LHGALTHD<STR|CT . /30 South *m°rim"" Street 300 vves+ Oak $w°t /nx sv=om°re Street 814 North ^o^ s+met Stockton, California Lodi, California Manteca, California Tracy, California c"_9_2" =5446^,~"". .°°