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__ FOR'OFR{EU3E <br />APPLICATION FOR SANITATION PERMIT Permit No. <br />(Comp|mfo'in Duplicate) <br />­__ I This Permit Expires 1 Year From Date Issuad <br />Uu+u issued �'�����/�k <br />Application is hereby made to the 8*n Joaquin Local Health District for* permit +oconstruct and install the � k� ,*i 6 D» 6 <br />This application is made in compliance with County Ordinance No. 649' �� ' o » *,cr r ' <br />JOB ADDRESS AND L0qCATION_._.�? e!f <br />........ /a .. // -------- -----------­----­- ----- -- <br />Installation will serve: Residence R�`Apartment House 0 Commercial [j Trailer Court [] Motel El Other <br />Number of living units: _/.. Number of bedrooms Number of bafhs--/--- Lot size <br />Water Supply: Public system Ej Community system D Private 9?'Vepth to Water Table <br />Character of soil fo a depfh of 3 feet. Sand El Gravel L] Sandy Loam E] Clay Loam El Clay V?""Adobe El Hardpan [I <br />Previous Application Made: (if yes, date ................... <br />) No 251'"New Construction: Yes El No 2�'FHA/VA: Yes E] No R4— <br />rz ur /nu/ALL*oOw AND SPECIFICATIONS: <br />(No septic fank or cesspool permitted ifpublic sewer is available within 200 feet.) <br />Septic Ta Distance from nearest well --------------- from <br />foundation.. <br />�-W^~^'°�No oFcomp*�mon/c ' -ho+ar'n| <br />---'-------'''-- <br />�b---�q � depth.. <br />Capacity--------- <br />DisposatR Distance from - �/ <br />.. Distance to nearest lot line <br />Number of lines ^ <br />Type of filter material Depth of filter material-.- law <br />ee page Pit: Di:sf�`nce to nearest well_/� <br />ion <br />-----' '" <br />""`ar-°-'r--/-o'-r --/Nmmbe, of p�,- -^- <br />.�--_g muor-�'--r'^'~% <br />-----Cesspool: Disbncnfrom nearest well ---------------- Distance from foundation --------- ' L-' material `-----'---'----------'�--~'^- <br />'LJ Size-. D:amo+ c __ ----- '---'--'------_.Uouid CouocUv It <br />Privy: Distance from nearest w*k--''---- - - ----'-- Distance from nao'"`. building ----- <br />EJ Distance to nearest lot line-.,.--., <br />��''����''��-�'��-��� <br />Rrmo6e�gand/or �pu��g�:�,�:)�_--. ~7--- ' <br />--._--__...__.-'-_--__--- -.--------_-~----''_---_--'-'-''-_------- <br />'........ --............. ---'-_---'----------------- <br />'.......... ........ .............. --------- ----- .......... ......................... ------- -------- --------------------------------------------------------------------------------------- .................. <br />�--' -_''-'-_'_-'_.... -... ------- ---- ------ ............ --_------------------------------------ --_- <br />-'--- <br />/ hwork <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />(4���or Contractor <br />will be done in accordance with San Joaquin County <br />': --_ <br />�- <br />(01�1'plan, showing size of lot, location of sysf�errt i a-frion to wells, buildings, etc., can be placed on reverse Sid - e]i <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ------ <br />Alterations and/or recommendafions: ------ <br />FINAL INSPECTION BY:,. _'--- D^m_3~��P~« J�- <br />\ �a&\�---- --....... <br />SAN JOAQUDNLOCAL HEALTH OBTBkCT <br />1601 F, Haislion Ave. umoWest nmk Street /2wSycamore Street <br />m=km"'w"«v�"/" Lodi. California mp»/,=`c"n�,"/" z»s w+"'�� m`""^ <br />