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�- APPLICATION FOR SANITATION PERMIT Permit No. . (Complete in Duplicate) Dote Issued W ------- Applica-lion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinan e No. 549. JOB ADDRESS ANDA�OCATION -------- A4— Installation will serve: Residence g?""Alparfment House El Commercial E] Trailer Court 0 Mofel [I Other Ej Water Supply: Public system ��Communify system E] Private F] Depth to Water Table .5;�e ft'. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam E] Clay F] Adobe 8--H-a-,dpan E] Previous Application Made: Yes E] No 2�Ne, Construction: Yes 0 No F1 TYPE OF INSTALLATION AND SPECIFICATIONS; a 4e (No septic tank or cesspool permitted if public sewer 7ea`vaiIabICeAwwiwf hVin 2'30�fere�q Se f' T A: Distance from nearesf well----- ------- Distance from foundation----A- -.Material------- --------------- Disposal Field: Distance from nearest weU-----------------Distance from foundation------------------- Distance to nearest [of line----_.. 0 Number o{ lines-----------------------------------Length of each line------------------------------Width of french---_---__.- ~- Type of filter motoruL''--'-'-'Danf of fi�ormoter�L-_�'---'T�u �no+6'''-''_-_''_-_'_-' ~~ 3eepu PH: Distance to nearest wnL-..----------Distance f ~ Distance to nearest | / ' Number nfpits-'--/------....Uning ma+er;u| ize:,Diak- -^''-- V1 Cesspool: Distance from nearest well----------------- from foundation------------------- Lining material -------'---__ � [] Size: Diameter --- --------------------- -----------Depth----------------------------- --- ------------------Liquid Capacity... ------------------------gals. Privy: Distance from naun,`+ nrli-'_-'_''--�'''-'''--Distuncv from nearest building.'-''-'''-'--'-�___ [] Distance to nearest lot line----------------------------------------------- ._______.______._____.____�__ Remode|ing and/or repairing (describe):----'''-'''''''---'- ---------------------------------------- ------------___----_--____-------__.-'_-__.._--.__.-___----_._-_------__-'--__-_--'--- -_-'-'-'_-'-''---'___-'-_--'-'--_'--'-__._-__.-_-''---'___---'-__.-_-'-''_-__.-_.'''-''---'-' ---__-_-----'----.__..__-___'__---'_.__--.__._..__-.__-_---__--__----__-----. I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin County ordinances, Sfafe_laws, and rules and regulations of the San Joaquin Local Health District. (Plot plan. showing size of lot, loca+ion of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ - ------------------__-------- TDATE -73jT- -0- --------------------- REVIEWED BY-------------------------------------------V-------------------------- ----------------------------------------------- DATE--------?7 '-'-''--''----'''-^''--'----''---'''--''-----''''-'-----'''--''---'''-'''-----''-----'--'---'''-- --------- ----------------------------------------------------------------- -------------------------------- -------------------------------------------------------------------------------------------------------------- '-_'---''--'-'-----'---''''_-''''-''''--''''--'''---''-'--'''-'''-'-''-'''_-'''--_'-'-'-'__.-' ------------- '''_-'''--'''_-'--''''------------------------------------ '�'-'''_-'''_'''-'-''-'''-'-_' . FIINSPECTION BY�_��^��'.--_-.-------- O*+e''- ^�/~~ �Y'~-'�� -'-'-'''-'�-'--- 7 SAN JOAQ0NLOCAL HEALTH DISTRICT ~ 130 South American svmm 300 West Oak Sf,°m mx Sycamore Street 814 North "C" Street $""km". o"/av,"ia Lodi, California Manteca, California Tracy, California ' ` ES-9-2M n°visedvv-2/oo ----