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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> . , <br /> App|icu41on is hereby noo6o to the San Joaquin Local Health District for u permit to construct and |n:toU the work herein described. <br /> This application is made in compliance with County Ordinance No 549 <br /> JOB ADDRESS AND �PCATIPN ------------ -----------------__/2' ------------------- <br /> Installation will serve: Residence Apa ment Ouse 0 Commercial [] Trailer do��'urt 0 Motel Other 0 <br /> Water Supply: Public system [I Community system [] Private`� Depth to Water Table_:;�ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loa7�k Clay Loam E] Clay 0 Adobe E] Hardpan E] <br /> Previous Application Made: Yes E] Nov New Construction: YesZ' No E] <br /> , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sower is available within 200 feet.)pfic � <br /> Tank: Distance from nearest well-----------------Distance from foundation. ----__Material ---.-------------- <br /> No. of compartments--------------------- ---- -..----------------------------Liquid 6eR�h--------------------------Capacity----------------------- <br /> : Distance from neon�twed-'-- ..-Distance �om foundation Distance to nearest �tSno'-'-'-- <br /> Disposal/ <br /> Number of lines------------Length of each |ine---.--..,.�_-VM�f of trench----------------------------------- <br /> Type of �|tv, �ufo6nL----.---Dupt of filter moto6u|�'.-�.--'-Jpt | length-----------^-?~ ' 0/ <br /> Pit: <br /> � <br /> Seepag : Distance to nvun:� w�L ^�v4—' 7( D +o ms �� k <br /> m� Number of pits------{--------------Lining mate ria| � --unn <br /> ~�, �n�� ��� u/oote,-_�..7---- ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--- ----------------Lining motoriaL--_--._'_- <br /> [] Size: Diameter--------------------------------------Dept --- ----------------------- Capacity----------------------------gals. '\ <br /> Distance from ":st building <br /> Remodeling and/or repairing (describe):...... -- ----- ---- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and-hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and ules an re lations of e Say(�Oaquin I Health D* ' . <br /> ------- ---- - -- -- ------ -- n be p' cei��o:n `verrpkidie_� <br /> FOR DEPARTMENT USE ONLY <br /> ---_' - PERMITAlterations nd/or ' <br /> recommendations: ----------- <br /> ____.__-- <br /> --.- _.—___---- <br /> '----''�t- <br /> --''__'--'�-'�---'��-''--''---'--'--'''--'��'''---''--''-''°--'_'`�~_'-__.''-_'--'--.--'''--. <br /> -----------.------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------- <br /> RN/\L INSPECTION BY:-------------- ------------------------------ ------------------ Date----------------------------------------'_''-''--'---_-. <br /> SANJOAQU|NLOCALHEALTHCUSTRICT <br /> /so South American St=et ' smoWest Oak Street 132 Sycamore Street m* worth "C' Street <br /> s*=kto". California Lodi, California Manteca, California n="', California <br /> ES-9-2wRevised W-2100 <br />