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` ---- . <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in <br /> Duplicate) <br /> Date Issued -�Z.������.�~' <br />.' ires I Year From . <br /> Application is hereby made t� the San Joaquin Local Health District for a <br /> install <br /> mwmpp|cut�n � made 7 compliance w�h\County {}nJ ' construct-- -- '-- ''~ '-^ ^~'~'~ described. ' <br /> 04 JOB ADDRESS AND ATION------Iall <br /> ----------------------- <br /> --'--- - Name----- <br /> Number of living ns: � <br /> Water Supply: Public system 1� M"Ibommunify system [] Private E] Depth to Water Table 30' ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel 0 'Sandy Loam El Clay Loam [3 Clay 0 Adobe gal"Hardpan 0 <br /> Previous Application Made: (If yes,date------------ -------) No [3 New Construction: Yes E] No P""FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from foundation--A.....r----Distance to nearest lot linfi.,,4......... <br /> DisposaVield: Distance from nearest weAd/._, <br /> 11 11 r I <br /> ��e u|�ance +o nearest <br /> or Number c� Pitt-------/------------Lining n`oforio| Dium*tor--����-._-Daot�---. ���..--' p*.� <br /> Cesspool: Distance D�t ��o'fn,m foundation material------------------------------ <br /> [] Size: Diameter --'''-''-'''''-Depth---------------------------------------------------Liquid ----------------------------gals. <br /> 11 <br /> 1 <br /> ----------------------------------------------------------------- <br /> —''-'''--'----'---'---''--' ` } <br /> I hereb certifr that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance$, La <br /> W75, and ru s and regulations of the San Joaquin Local Health District. <br /> _(O or and/or Contractor) <br /> -_' ' <br /> (Plot. plan. showing' " size "~ �. �°�"�" �v no�nnn to wells, buildings, erm, can be placed on rmvmrs» side). � <br /> FOR DEPARTMENT USE ONLY <br /> J <br /> --'~-^~ BY <br /> - '��'�' <br /> _°�* ____________ ' <br /> 11 <br /> ---------------------------------------------------'----------'---- <br /> ------------------------------------ -_.''--''---'--'-_-''-'_-'-_.'--''--'-----_-- <br /> -------.--------. ---_---.--._---------------.-__-.-. <br /> FINAL INSPECTION BY:-. Date_ �� --_� <br /> '�r`-'------'------' --��~ -' <br /> /^ | <br /> _ SAN JOAQW|N LOCAL HEALTH DISTRICT ' <br /> ^ <br /> 130 South Arnsirlean street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,Callfornla Lodi,California manteca'Califormm Tracy,California <br /> ES REVISED 8-59 n" u'e/ ATLAS <br /> U ^ <br />