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� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> .. <br /> (Complete in <br /> Duplicate)`-- <br /> Date Issued - <br /> / made the San Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> e4Add -3 ia <br /> Con�ac�noNomo-.. ._'_._--.-_.----.-------__'_-----.. Pko"e-_ __-----. <br /> |nstallationwil| serve: Residence E!� Apartmen+ House [] Commercial [] Trailer Court E] Motel E] Other <br /> Number ofliving units: J-.- Number ofbedrooms ^q- Number of 6athssize -/ �-m ��� -~/��.{J .------ <br /> ' La-at. <br /> Water 'Supply: Public system E] Community system �� to Wafer T�e/��.. ^ <br /> Character of soil to a depth of 3 feet' Sand [] Gravel E] Sandy Loam [] . Clay Loam [] Clay E] Adobe n:�_Horclpan El <br /> Previous Application Made: Yeo � No = `~ New <br /> Construction: Y- <br /> - [ <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool parmRfm6 if public sewer isavailable within 200 feet.) ' <br /> Septic Tank: Distance fromnearesi ||,9/�1 from fo J 1 0 �t�2������ <br /> No. ofcompartments-..�)-----..S�zu-��'��.��'`�.T._-.Liquid dep+h--��=----.Capacity--mi-. <br /> ~ «�-�� � <br /> Ui,posu| Field: Distance from nou,e,f woU-��.^�-.Distance from foundnt -'/.�l---Di, <br /> Number of linesA �oc� line �� �� VV|�f6 of-.. - � --~_- ----� _ <br /> ` <br /> ch- <br /> Type of fi|+u, material dQCof filter mu+crioL.}7.L-._Jo+u| length_.1. [ <br /> Seepage Pit: Distance to nearest well------ ---------------Distance from foundation------------------- Distance fo nearest lot line'--''-- <br /> [] Number of pits-------Lining material------------------------ Diameter---------------------�Depth-_---_---. <br /> Cnspon|- Distance from nearest well-----------------Distance from foun6ufion....................Lining material-------------------------- <br /> �� 5�e: Dioma+e,�---._'_----.-Dept k_-'_-.__--------..UouidC*poc�y'-__._--_-gu|s. r\ <br /> Privy` Distance from nearest weU�----'--'''-_'--_-'Distance from nearest building------------------------------------------ <br /> F-1 <br /> '--''-_.'-'-''-'-F-1 Distance to nearest lot |�no--------------------------------------------------'-_-_-----_._.__._______._.___-___ <br /> Remo6eing *n6/n, repairing �c��_--__'_-__.________._____ <br /> _---_-___----'''-'''_---'--'''--.-''-__.--_''--'''--'-_-'___-_.'-'-'-'--.'__-'_--_---'--''-' � <br /> '-_-..-�----_--._-----__--_'__-.__---___-___..--_--__'----.-__---..___'_----_-.-_-- <br /> ----'----------------'--------'--'—''--------'-----'-'------'------'---- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San'Joaquin Counfy <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plane. owing size 4 lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> - ---'''''---'_- DAT- <br /> '__-' ' <br /> FINAL. INSPECTION BY:-------------ia�a.Z_ !­----- - ------------ Date__._.41z.3J -------------------------------------------- <br /> , <br /> SAN JOAQUONLOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street |oz sycamore Street m* North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ss-v-zw n°.is°a vv-2/00 / <br />