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, // � APPLICATION FOR SANITATION ,..AM� Permit No. '^��-_. (Comp��a� � C�o�a�\ 7� lete Duplicate) Du+o Issued _-(--.�.---L Application hereby made to the Son Joaquin Local Health District for u pnnnif to construct and install the work herein Jenx,6nd. This application is made in complianz5olfh Countyrdinance No. 549. 1 &44.�4v JOB ADDRESS AND TI N_ -I--A9-- ----------- ------------------------------------ Installation will serve: Residence x Apartment ouse E] Commercial F] Trailer Court E] Motel [] Otker Number of living units: Number of bedrooms _��Number of baths --- Lot size Wafer Supply: Public system El Community system El Private YDepfh to Wafer Table -4- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam 0 Clay E] Adobe Y Hardpan E] Previous Application Made: Yes E] No K New Construction: Yes 4 No 0 FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: jNo septic tank or'cesspool permitted if public sewer is available within 200 feet.) Disposal Field: Distance from neare i well-10D.4-Distance from foundati-w-- Ok- Distance to nearest lot)�ne___-!�--- a4e0e p,g e AP, Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- [] Number ufpits------------- -----.Lining material----------------------- Diameter._---._Depth---------- ---------------------- Cesspool: ._----..Co s,on : Distance from nearest well----------------- from foundation--------------------Lining motnhoL'-'-''-'--'----- [] Size. Diameter.---_---:------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy Distance from nearest we|L'-'-'-'''-''--''_'-D�s+onc; from nearest building''� ----------------------------------- Distance to nearest lot -----'__'-_-'-'''Dist*nne +onoun,,t |ot lire`------------------�—_-__-_--_--'-_--_______.--.__—.. ' Remo6ning and/or repairing (describe):-.-''--'''_''' ---------------------------------------------------------------------------------------------------------------------------- ------------'--'---'-----------------'-'---'------'--------------------------------'------------- '--------'----'--'---`—'--''----'-'------------------------'--'------------' ------------------------------------ ------------------- ----------------------------------------------------------------'------------'----------- I hereby certify that I have pr pared this application and that the work will be done in accordance with San Joaquin County ordinance$. St e la , an rules d regulafio7� of the San Joaquin Local Health District. 941;iq W_ _ ---------------6-------------------------------------------------------------------(Owner and/or Contractorl (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on"reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------------------------------------------------------------- DATE._----._---'—_--_-' REVIEWED BY' BUILDING PERMIT ISSUED------------------------------------- D�TE---�_-��..-��'--_---__ A�erwt�nsand/or reoommon6a+�no�--__-_-/�..�-�-��.��.-----.--------..___--_-----_-_-.__-------------------------------------------- '--'--''--'----'--''-''--'''---'''--''---''''--'-'---''---'--''''--'''-------''--------- � --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- �'-------------_----'---------------------------------------'��-----_---------_-------'-------------------------'-----------------'------_-----------'---------------------------- � ------ -------------------------------------------------------------- ''-_.''''-''-'_-'�---''_-'-'-_''-''''---- RN/\L INSPECTION BY:--''-- Date--------------- ' ��` -^�� ' � '-'''___ , , SANJOAQU|NLOCAL HEALTH DISTRICT /30 South, American Street 300 West Oak Street mxSycamore sfreer+ m4North 'cStreet Stockton, California Lodi, California Manteca, California Tracy, California ' ES-9-2wx=i"°" 1'57 pzco.