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APPLICATION FOR SANITATION PERMIT Permit No. <br /> `- Duplicate) <br /> —`-- ;n <br /> Date issued .. <br /> ��3 <br /> Applica-�ion is hereby made to the San Joaquin Local 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 /> Yndallatiom will serve: Residence [] /\portmoo+ House [] Commercial [3� T,n\}ar Court [] Motel [] Other [] <br /> Number of living units: -------- Number of bedrooms -------- Number of 6o+ks --- Lot size -- ----' �~ <br /> Water Supply: Public system Ej Community system El Private JgL Depth to Water Table k.?_ ft, ' <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam E] Clay Loam 11 Clay El AdobeJ9_ Hardpan El� <br /> Previous Application Made: Yes E] No 4 New Construction: Yes A No C] <br />� <br /> (No septic tank qrcesspool pp,mnr=o if public sewer mmva/xmm/nw/nmm 200 feet.) <br /> Septic Tank: Distance f from fo d ����� C ��� <br /> ANo. of compartments _ `_- - depth _ --.-Capacity----__-'_-' <br /> '� <br /> Disposal Field: Distance from nearest woU���x.��f-.Disfuncn from found*+i '-Distxnca to noon,,+ |o+ line----- . <br /> Number of <br /> LengthOQ ? — -Type of filter material--,/ '. �� -De h of filter mofori*L.- ° --Total length-------- � <br /> 5napugn P|+: Distance to neu,os+ weU- Distance from foundation_ Z/ r �� to ne*,o^t | | lJ <br /> ED~ Number of p|�-' ��--._.Uning mmto6u|.«��� : O[ume+er-7 ���-- --Depth--. ~ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------------- material--- ,� <br /> 11 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-...---- <br /> Privy: Distance from nearest well ----'''--''''''--Ois+ance from nearest building '-'''--'-_.------' <br /> F1 Distance to nearest |n+ line-------- -------------------------------------------------- ---------------------------------------------------------_______ <br /> Romo6eling and/or repairing (describe): __' ' ' _- <br /> '------------------------_''�p-'-----'-------'-'~~-----�r ---'------'-`—`----'---' <br /> ------------------------------------'__._----___ ---------------------- -------'- -------------------------------------_------------------------------------------------------- -- <br /> ------------ -------.-------.-------.------------.---------------------------.---------.----.������������������­­---------------'-----------'����������- <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, Sta�fes, and rules and regulations of the San Joaquin Local Health District. <br /> (Sione6)... '-''--'' and/or <br /> -''_ __--------------------- .-- ......~-_.------ --------_--- <br /> (Mmfplan, showing size of lot location of system inrelation fn wells, 6uU6|ngs, etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED DY--.- -------------_--.----.. DATE�---.------- ---------------------------- <br /> REVIEWED <br /> -___.. <br /> REY|E\* BY------ ------------------. ��' <br /> 8U|LD|N�� PERMIT ISSUED_---_��._�-�����---_--.---_------ -------------------------- DATE----------------------------------_____ <br /> Alterm+ion^ an6/mr,recommendations:------- .......................... --------------------------------------------------------------------------------------_-_-__.__.__. <br /> ' <br /> '- '-'''-'' '-'''' —'-''---'---''---''''-''----''-''' <br /> �- ��^~4 ~��-'-_ _^--���'�--�'��- --'-----'-------'---'----'—'' <br /> '--.-'-'-''----''---'''---''-''''-'''-- ''---'''''-'''-_.-''-_'''--.-'-_-_''__.'''-'''-'--'--''' <br /> .--'-'-'-'''_-----''''--''--_�--�'—��''--,''''—_—''''''-''--_''''-''--'''''-'''-'--'--''— <br /> � ^� ��� <br /> FINAL |N6PEI�T|[)N 8Y�- ''-''—'''-'''—. Omh�--'�'~_.',-��—�'sx��.'''-''-�--'--- <br /> SANJOAQU|NUOCALHEALTH DISTRICT <br /> |nn s"mh American Street 3onWest Oak s+re°v |sz Sv*^mvw Street 8/4 worth ^o'' Street <br /> Stockton. California Lodi. California xxoo+woo. CaVfom|m Tracy, California <br />