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� <br /> APPLICATION FOR SANITATION PERMIT Permit M <br /> (Complete inDuplicate) Dufo |ssue�-/ !_/ __�>Application is hereby � <br /> made to the Son Joaquin Local Health District for u permit to construct and install the work herein descr;bed <br /> This aonlicafion is made in compliance with County Ordinance No. 549. <br /> JOB 'ADDRtS'S AND LOC�� ION__e��Z_Z&----O'd _ ---- ---- -------- --- - ------C;6��­­---------------- <br /> Owner's Name- <br /> Installation will serve: Residence 0 Apartment House El Commercial A-4a4er Court [I Motel 0 Other 0 <br /> Water Supply: Pubiic system 0 Community system E] Private [?��epth to Water Table _V ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam Fj- Clay El Adobe 0 Hardpan <br /> Previous Application """de` Yes k .," M New ..,,..,~...,. ',~ 0 No <br /> TYPE C)PINSTALLATION AND SPECIFICATIONS: � <br /> (Nm ooptic +ank or cesspool permitted Rpv6|& sewer is available-within 28OfeefJ <br /> ' <br /> / <br /> Septic Tank- ' Distance from nearest well---/J-. /.Di,h,nce from foundf�on-.~~�0-r...Mutu�ri | � � <br /> . <br /> -..4 ��No. ofcompu�men+s---�_----.Size-. ...---_Liqui6 dnpth'44 ----.CopucJty .- ..i <br /> | Fi |dDistance from nearest well��- Distance from foundation .�Didunua to nearest lot line.---.- <br /> Num6u, _.-.^ <br /> ,. <br /> o{ |�*s�------._--.LengH` of �oc6 |inu--_--�_--.-VVi6+h <br /> nffnonc�---_-.-.�--'�_ <br /> Type of of moh,�n�._''---�pt | length------------------------------------------ <br /> Seepage -- <br /> ' ~ p : Distance to nearest well .ISV------Distance from d -� Dirtano, to nearest lot line <br /> Number ofpits-------/---..Lining material-A;--x�°w��._S|ze: Diameter---- <br /> Depth--- <br /> �����-.���!-� <br /> Cesspool: Disfoocu from nearest well-----------------Distance from foundation------------------- Lining material --.--.-----... ' <br /> [l Si7": Diameter --'''_'''-''-Depth------------------------------ ---------------------Liquid Capacity--'-'-'-''-'gals <br /> Privy- Di0nc: from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ <br /> Distance to <br /> -_----_.-----Distoncofo nearest lot line'''-''''~------------------------------- ------------------ -------- ----------------------------------------- ____ ' <br /> � <br /> RemoJning and/or ",po�r�ng (describe):--''''--''-'''-----'--___''-__-'__.''-_.__-'___'__'__._,__.___.____ <br /> __-'._-_--__--_--.__.___-__-.__'-_---.--____-.___-_-----_--_-.__-._---_-----' <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------­-------------------------------- <br /> ------------ -----------------------­-----------------------------------------------------------11----------------------------------11--------------------------------------------------------------------------------------- <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 and regulations of the San Joaquin Local Health District. <br /> 8v -__----.-.�T���-----------..---..-______ <br /> (»�fplan. - - ' ' in relation 6* wells, 6uJJinGp, n+c. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -'--''-----''-_-''''--'''_-''-'_-'�'--'''-.''--''-'-_-'''----'-_--'--''-''--__.''_-'-_.'_-.-'-- <br /> -'--'---------'---------------'---------------'-----`--'-----'-------' <br /> ___________________�_�_______________________________________________________________________ <br /> '-'-'''--'-'''--' - -------------------------------'-'-''---''�-'-''''-''''-'''-'''--'''--'-----------'- <br /> �_ 7 r � <br /> mw _+~ , ~��� <br /> FINAL INSPECTION BY44' 4 ------.. Date------- -------------_.-__-_ <br /> SAN JOAQU(N LOCAL HEALTH DISTRICT , <br /> oo S""m American Street 30mWest Oak Street /sz Sycamore Street m+ worth ^o^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised vv-2100 <br />