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APPLICATION FOR SANITATION PERMIT Permit No, <br /> This Permit Expires I Year From Date Issued J`1?_ciLz <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and installthe war$ herein described. <br /> This application i�_macle mpliance with County Ordinance No. 549. <br /> Installation will serve: Residence [I Apartment House E] -Commercial 0 Trailer Court El Motel [I Other 56 <br /> Number of living units:t�m_ Number of bedrooms _�. Number of baths =... Lot size ....MR-Al.................... <br /> Wateir Supply: Public system [] Community system Ej Private PQ Depth to Water Table ........ ff. <br /> Character of soil'f* a depth of 3 feet: Sand E] Gravel C] Sandy Loom E] Clay Loam JZ Clay 0 Adobe[] Hardpan C] <br /> Previous Application Made: I if yes,date------- ...t......_) No $ New Construction: Yes DK No E] FHA/VA: Yes No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> '. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-Al FZ.Distance from foundation--a-*... <br /> Disposal Field; Distance from nearest well-AP.9-iFt Distance from foundation......Yl.^.Distance to nearest lot line................ <br /> Type of filter mafeial*4_1t'..��..Depth a <br /> Seepage Pit: Distance to nearest well.1 YO.-Pr.Distance from foundation---0A.Frjr_Distance to nearest lot line--- <br /> Remodeling and/or repairing (describe):----- ----- - <br /> I Ihereby certify that I have prepared this applicaf ion and that the work will be done in accordance with San Joaquin Cou +y- <br /> ions of the San Joaquin Local Health District. <br /> ordinancet;, State laws, and rules and regula+' In <br /> JPI*+ p-Ian, showing size of lot, location of system in relation to wolfs, buildings, efc., can be placed on reverse side). <br /> FOR DEPV=tTMENT USE ONLY <br /> Alterations and/or recommendations: r <br /> .......-.................. .................................................................... .............................----_-- ................ ............ ................................... <br /> -___ <br /> FINAL INSPECTION BY-_.� ��a--��'^�' -- Date_- ^� <br /> � - �� / ,-_��,-----.-_-_----�~-.`- <br /> SAN JOAQDINLOCAL HFALTH DISTRICT <br /> 160/ E. onw//°"x.°. 3**WemOak Street 1z*x',on°*nStreet 205eo`/9/h Smw/ <br /> ww^'o", cm//"m/o Lodi,California Manteca,California `,o'xCvm",o/o <br /> ,xu� <br />