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APPLICATION FOR SANITATION PERMIT Permit Nor. <br /> ^ . in DunU�afm , � <br /> � ' Do+o Issued ' <br /> ` _ ' v <br /> Application is hereby made it the San Joaquin Local Health District for"a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> Contractor's Nai �.ze,_ __2 --------------------------------------------------------------------------------- Phone <br /> Installation will serve: residenceg Apartment House E] Commercial E] Trailer Court E] Motel El Other F-1 <br /> Number of.living units; -------- Number of bedrooms ----t__ Number of baths --- Lot size <br /> Water Supp'ly: Public system E] Community system El Private/El Depth to Water Table----------- ff. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] 'Sandy Loam E] Clay Loam 0 Clay El Adobe El Hardpan <br /> Previous Application Made: Yes E] No New�Consfruction: Yes [ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permittud-iflulli-E'-sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-------------Disfance from foundafion_____!t�_0------Maierial---c", <br /> ---------------- <br /> Disposal Field: Distance from nearest well-. <br /> Seepage Pit: Distance to nearest well---- <br /> -Distance from foundation... to nearest lot line----- <br /> ------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of fhe San Joaquin Local Health District. <br /> -----=em in relati, <br /> (Plot plan, showing size of lot, location' of system in re ation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCE <br /> REVIEWED BY------------ _71 <br /> Alterations and/or recommenclaf ions: <br /> _-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- � <br /> `.__._-_--_--_.--_-.-_.----..----.=----_-------_-._----_-_-.-----------�---------------------------------- <br /> '-'' <br /> ----- . <br /> RNAl INSPECTION Y ~'/^ -- --- -.- � Dote------- <br /> SAN JO <br /> -..SANJO AQUUNLOCAL HEAL.�F. DISTRICT <br /> -''-'--.'_-'��-�----'- <br /> '-' <br /> � <br /> 130 South American s�"� <br /> .~ �w wv°mu"-SM of-_-' /on Sycamore Street aw m"*h "C" Street <br /> Sf" kfo". California Loai. California wo"wc*, California n*pv. California <br /> ES-9-2M 8-51 Revised W-2100 ' | <br />