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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Comolete in Duplicate) <br /> This Permit Expires I Year From Date Issued r_)_!57e <br /> Application is hereby made to the San Joaquin Local Health District for o permit to construct and install the work herein described. <br /> This application is mad= incompliance with County Ordinance No. 549. <br /> |nstuUo0on will serve: Rooi6onco F Apartment Hou,n 0 Commercial [] Trailer Court [] Motel 0 Other [] <br /> Number qfliving unit,: !-- Number pfbedrooms Number of baths Lot size ------.----' <br /> Wmter Supply; Public system [] Community system [] Private Ofl Depth to Water Table 30' ft <br /> Character of xol| to m depth of fwn+; 3un6 E] Gravel [] Sandy Loum W Clay Loam [] Clay [] Adobe [] Hardpan [] <br /> Previous Application Made: Ye, [] No [2 New Construction: Yes [1 No FHA/VA. Yes E] No <br />~ ~ <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank orcesspool permitted if pu6kc:'iewer is available wYt6in 200foetj-���=��.��.~ <br /> � � <br />~ <br /> Septic U----- ---_---�� <br /> � Tunk� Distance o <br /> [] No. ofcompartmunfs--------------------------Size-------------------------------Liquid clepfh---------------- ---------Capacity--'----- Mn <br /> Disposa| Field: D�stancufrom nearest well----5.0--------D�stun*, from {ounclmfon._;�*u-.--'Distance to nearest lot |in~4'------------- <br /> Number of <br /> _-- <br /> N berofU lLength of each | } �� / <br /> � <br /> Rnmo6eling and/or nepair;ng (describe):-- ___''__''__.-_.-'''________. <br /> ���1--''------'-------------------------------------------------------'---`-------'------`'----------'�������������������������---------------- ---- �- <br /> --'---'-'-''-'''-''-'''-----'--'''-----'-'--''--''--''--'--''-----'--'''-''--''----''-'-'--''- <br /> -----'-----------''---------''--'-----------'-------------'-------------' <br /> | hereby certify that | hmvo prepa�pd this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and rjegulafions of +he San Joaquin Local Health District. <br /> �y�--__._---__--.__.-._---��.--_-._--.---____-..�-_.. ����-.������.��..�����--..��.�-�--�� <br /> (Plo+ plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6wplaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> REVIEWED8Y----------------------------------------------------------------------------------------------------------------------------- DATE------.-_.-----_.--._-- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------- �-------------------------------------- DATE----_--._--.-__-_-� <br /> Alterations and/or recommendations:------------------------- -- --------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------- -------------- ---------------------------------------------------------- ----------------------------''---------------------------- ----------------------------------------'---------- <br /> ____________________________�__ --- ---- ------------------ _ ------___------_ ------------------------------------------------------------------------------------------------ <br /> --------------------- ------- ---------- --- ----------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- <br /> ----------------------------------------------- ----------------------------------------- ------------ ----_ -------------_____________________________________ <br /> � <br /> FINAL INSPECTION ''-'�� �''-' Umt�'��� ����� ---'---'---''-'- <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> /oo s""m American Street 300 West Oak Street /ux s,""m"re s»==+ ow w"*h ^c^ Street <br /> om"kto". California Lodi, California Manteca, California rm"v California <br /> m-9-21A Revised VwF,Co. <br />