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/ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ^� <br /> *� �n Duplicate) <br /> (Complete '—` ` Dutn /ymod _�L�--3141 <br /> Application is hereby made to the Son Joaquin Local Health District for a permi't to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ."-t4j�? <br /> Installation will serve: Residence A Apartment House 0 Commercial Ej Trailer Court [I Motel E] Other E] <br /> Water Supply: Public system El Community system E] Private K Depth to Water Table A ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [:] Clay Loam El Clay [__1 Adobe ExHardpan E] <br /> Previous Application Made: Yes E] No K New Construction: Yes E] No �kFHA/VA: Yes E] N�ro <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer isavailable within 200faofJ <br /> Septic Tank: Distance f | J". / <br /> No. of compartments-------1--o-------------Size_IZ�___q ------------Liquid depth------ ---?'Ve--------Capacity---e-I --------- <br /> IX <br /> Disposil Field: Distance from 30.A <br /> C� <br /> �Number of |� - ' V each |in�'.� �.-'' Width of <br /> trend <br /> Type of filter ma+e�a|-3i �w � o+ qf �|fer mn+n�oL-..,1. ---------Total length-------/1& ------------------- <br /> Seepage <br /> '---'`--Seepogelot <br /> � ( <br /> H+� ��t nc� to n�ur�� �o|`���----_D��nc� from f�un�u�on_''__-_�Di�oncefo n�u,�s �� |ina-�'_-'- <br /> E] Number of pits-------------- -------Lining material _---_---5izu: Diameter-_-------_Depth--------------------------------- <br /> Cesspool: Distance from neunestweL--._-Distancofrom foundation------------------ mmtrrivL--,��._.__-- <br /> El Size: Diameter���'-'''_--''-Depfh--''-_'''�-''-_'''-__-Uoui6 Capmc����---'-'-'go�. ' <br /> - ~ ' . ' <br /> Privy: Distance from nearest well--'--''-'''-''-'''--Distance from nearest Emi|6ing------------------------------------------ <br /> Distance to <br /> '���'-''-''-''-'_-Didnncofn nouro,+ 7o+ line--._----.-- _ .__-.__-__-_�_'__________ <br /> ' mo6 ' <br /> .~ +. ~-°^�°"��`.`._.-^"=.�=`,=^^.��_^=,_=-'`�.°�`°°"=.°~". <br /> - . ` <br /> .- .^���z�-~_--_-____'_-'--^--_-__._-----_---'_._--______-__.._____._______ <br /> ---L1''--_--''-'-__.'-''-_.'-^_'-__--'�----_'---_-___'_-._-_-_------_-.---._-_'__-.----___- <br /> __________________�________'____'___________'_________'____________-__'_____________ <br /> I 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 an regulations of the San Joaquin Local Health District. <br /> (Signed) ��u��. � <br /> . py:-------------------- <br /> idel <br /> (Plot plan, showing size Of lot, lo n of sy�stern in.relation to wells, building"-s, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------------------------------------------------------------------------------------- DATE------ -- -. <br /> KEV|EWGD 0L DATE------ <br /> 8U|LD(N�� PERW|T |SSUED.---_.---.--_----. 'xr��r��---.--- DATE---'------_-.----___.___. . <br /> AKe,u+ionson6/o, rocommen6mMnno---_-_-- ----�--.. ---____.-._---_._----__-_.__-._-_________ <br /> ,__--'--------''-'''_---.'----'_-''''--''-'-''-''--'-''-_----''-------.---_-''--'--_-----_.'__'-'_- <br /> . ._._----_._-_-__.---_-_-------_-----__.___.__--_�.-_-.__-.__---'-_'-__.___-. ` <br /> '--'-'-----''--''------'---'-''--''--''-''''-'''--''---''--'''-'''-'''---'''--'''''-'---'-''-''-'-' <br /> _____________________ _ __�________�______�_________�____ ___________' <br /> ~�~-- ~���� . <br /> FINAL INSPECTION BY:---- ----------------- Date---_----.----------_-___ <br /> SANJOAQU|N LOCAL HEALTH DISTRICT <br /> /nn s""m Arn=ica" sfr°e+ 300 West Oak Street /ox Sycamore Streem* w"*h "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ss-*-xw Revised 1.57 F.p�oz <br /> - - <br />