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\7 <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. ..- <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des ri e <br /> ,his application is made in compliance with County Ordinance No. 549. <br /> Installation will serve: R sidence Xpartmenf House 0 Commercial E] Trailer Court E] Motel E] Other E] <br /> Wafer Supply: Public system El Community system 1-1 Private Depth to Wafer Table,"O. ff. <br /> Character of soil to a depth of 3 feet-. Sand E] Gravel E] Sandy Loom Clay Loam [] Clay 0 Adobe E] Hardpan E] <br /> Previous Application Made- Yes Ej N 0" New Construction: Ye�� No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No � pu6� �w� � a,�a� w�� �� �e� <br /> .Septic Tank: Distance -Li qufrom nearest well---- -----Distance from foundation / � <br /> | <br /> | -- « � id6 ' �u <br /> Disposal Field: Distance from k- Distance from founclation--/ --Distance to nearest lot line---- <br /> '.1 <br /> Soepogu Pit- Distance� re, well Distance from foundation------------- ----- Distance to nearest lot / <br /> Ces,pqo\: Distance from nearest well .-'---..Distance from foundation------------------- Lining material-----------.-� <br /> .El Size: Diameter------------------------------ p+h----- -------------------- -------------Uquid_,C�afas:ity,,~.~~__ ---------- .gn|p. _ <br /> | Privy: Distance from nuuhvdwell----------------------------------- from nearest building------_-_-'-_ v <br /> El Distance tonearest lot line- <br /> Remodeling and/or ' / <br /> ' <br /> ---------------------------'--------------------------------------------------- ---........-'----'---------'''---'-----'''-''-'''-'-''----- <br /> '---'--------------------------'--'---''--------'-------'--''--'--''-'---'--'- <br /> ��-----------------------------------------.----------..-------------------.----------------------------------------------.��-----------''''------''''-----''-------------------''---'------------ <br /> preparedt6is application and that the work will be done in accordance with San Joaquin Cou <br /> ordinances, State laws, a d r es and regulations of the San Joaquin Local Health District. <br /> ti <br /> (Plot plan, show-1-1-9 0;io�.__io,;� on of system in relation to wells, buildings, efc., can be placed on reverse sid?e).,,�O <br /> $SDEPARTMENT USE ONLY <br /> 8U|LD|NG PERMIT ISSUED.-------------------------------------------------------------------------------------------:-------- DATE..---.___--.-----_-.- <br /> Alte,mMonoan6/o, nacommen6mtiono:-----------_------_--_'_---'_-_-___'-_-_._--__.__.-- <br /> / -'-_'-'-''''--'---'''--'--_''_.-'''---''---'''-'''--_-_-_-'-'-''--'''-'''--__--''-____.-_.''- <br /> | .-.--------.____--_-_-_----_----__-----._-'-_---._-._--_--_-_---._--__.--- <br /> -''_--'-''''''''---'_''.---'''--'''-_'-'-_--'''--''-_'''''---''_''''-'''---_--'''-'-�-'''-'- <br /> ---_---_����---__---____----------_---------____--_------___��---- ------------------------- ---------_____��----------__-----____-----_----_----___-----__---__---------- <br /> RNAL INSPECTION BY---- -. ------ ------ Dote----------------����-----_---l--------- ---------- <br /> . � <br /> � <br /> SAN JOAQ0NLOCAL HEALTH OISTRICT <br /> 130 South America" streof 300 West Oak Street .132 Sycamore Street m* North 'C' Street <br /> Sfo^y*". California Lodi, California Manteca, California Tracy, California <br /> ' <br /> ES-9-2M 10'52 Revised vv-2/00 <br />