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o <br /> ° <br /> AWL|CAT|ON FOR SANITATION pEnl�IT ponnit No. ' /� 7 � 7 <br /> ' <br /> ��mo�� � Duo�u�\ �/ /' � <br /> (Complete Duplicate) Date |o�oJ -�/��/��'. <br /> Applicafion is 6one6y nnu6a to the San Joaquin Local Health District for permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordin IN o"5499. <br /> A?VCATION, <br /> JOB ADDRESS <br /> 7 <br /> ------------.... ... .... . ............................................................. ------- .................... <br /> Installation will serve: ResidenceA Apartment House [j Commercial E] Trailer Court E] Motel 0 Other 0 <br /> Number of living units: -1----- Number of bedrooms I----- Number of baths -1.... Lot size Y--.-- <br /> Water Supply: Public system 0 Community system 0 Private VgLDeptk to Water Table 4157 ft. ' <br /> Character of soil to a depth of feet: Sand [] Gravel 0 Sandy Loam Clay Loam X C|ov [] Ado6o [] HonJnmn [] <br /> Previous Application Made: Yo, [] No �� ��Now Construction: Yo, No [� FHA/VA. Yon [] No <br /> ,_ ^� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Nn septic tank or co,,pvo| permitted /f public sewer is a"ui|u6|o within 200,fon+') <br /> Septic Tank: Distance from nearest .eU',!9V_�-..Disfanca from foundation.../-Z."----Mu+erio| - <br /> No. of compartments-1-.------ 6op+k..5-V_,,^_ --' Cupoci+y.. -- <br /> Di,posu| Field: Distance from noomd weU'&V'......Distance --------Distance to nearest lot 6ne.^!�-^-- <br /> OK Nvm6o, of linesof each line.-- IV <br /> Vi6H` of +n,n -' ^��� �� �op+6 of |+or mo+oriu - ' � �� ..'To+o| |ongth--- � � -_-'__Typu of filter muforiu <br /> � <br /> Seepage Pit Distance to 000,vs well......................Distance from foundation--------- ---------Distance to nearest lot line-.-_'-- -~�\ <br /> [] Number of pits .....................Lining material -......... ------Iio,: Diameter.......---------------Depth----.---_--.. <br /> .................................................. <br /> '--'''--'--'--- -' <br /> I hereby certify th h e prep ed f is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State ws, an rules reg ions F-+4T San Joaquin Local Health District. <br /> . / <br /> ^ ` <br /> . u>�.�~~~�- ___ --��x�~- .. - ��| --------1. <br /> (Plot plan', showing size of �t�|pc"Gon of system in po��on +o *��. buildings, o+�. can 6e p�cjd " ,ovo�e si6n).. . <br /> FOR DEPARTMENT USE ONLY <br /> -- . \ <br /> __--_-______-'_--.---'-----_-.--....-..-.-.-------.-_---'_-'------_------'-_--.-------_'-.---'-----_--------. <br /> ------`--------'--`—''-`---``-------'---'-------''-`-------`-'------'-------`---------'--'--'-----'-'' <br /> ---------''--''-----'----'-----'''--'----'-----------'-----'-------'--'---------------'-- <br /> 01 <br /> RN/\L INSPECTION 8Y .......... Dot,--. ' <br /> SANJOAQU|N LOCAL HEALTH DISTRICT <br /> /30 South American Street xooWest Oak Street /o Sycamore Street - o/* North ^o^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California ` <br />