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° ~ <br /> .OYI APPLICATION FOR SANITATION�U� <br /> � PERMIT Permit No. <br /> `�omm�� � Duu�a�\ <br /> \ Date |oxu�� <br /> -.���� �� �~ <br /> / <br /> ' Application is hnno6v made to the San Joaquin Local Health District for u permit to construct and install the work herein described. <br /> " Thisumlicut.ion is made in compliance with County Ordinance No. 549 <br /> ---------- <br /> Installation ... serve: .`~~..~.`~X '`'...merit House E] Commercial. E] Trailer. ~.... E] ....~. E] ~.... <br /> Number ofliving un �^um6e, of6o6,00my �Z Number ofbaths '/- Lot size - �x»y�-------. <br /> Wa+er Supply: Public system Communifsystom-� _PM" +a E] Depth to Water Table r��H` <br /> � Character of soil to a 6amthof 3� ~^feet: Sand E] Gravel E] ^ Sandy Loam F] Clay Loam E] - Clay E] Ado Hardpan <br /> � ! <br /> / -r ' <br /> � Proviouv Application Made: Yes ^ N New Construction:.u�,t�on� Yu'�k' �No E] <br /> TYPE OfINSTALLATION AND SPEC|FkC�ATCNS; <br /> � <br /> -~ ~ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ^ <br /> Sn96cTank' Distance from nearest well ''_--Distance from foundation--------------------WuterioL'''''-''''------'-- <br /> No. of compartments--------------------------Size--------------------------------Liquid clrp�k--------------------------Capacity.--.---- <br /> Distance from nearest weL-----Distance from foundation--------------------Distance to nearest bf line'-_-- <br /> ' Numbe, oJ lines-----------------------------------Length oFeock line---------- ----------------_Width of fronck---------.. | <br /> -�-y--- ~-~ <br /> Type of filter material ''--'-''-Depth offilter'ma+erial-----------------------Total length''---''-'-''-'-'.'�'' <br /> Pi e Distance to nearest �*0------Distance to nearest lot 0 <br /> -----Num6or of p�,- - Uning �iomn+oc~��� Depth_. ---------------- <br /> ------------- - <br /> � <br /> � <br /> Cesspool: Distance from neuna� .oU-_--.-Di�anco6nmfoundation-_-----Uning moto6oL-----._-'_._ <br /> � [] S�"� D��efa�''''''-'''----'''Do�+�'''''''''''''''-�.-'-'^-L�ui� Cupoci��-'-''-'-'-'oah <br /> . ` ' <br /> � <br /> Privy: Distance from nearest well-------- ''' --------------------------------Distance from nearest building'-''''�-'�'--'�-�� <br /> ' [] Distannntonvonsst |qt |i ------------------------_-_'__�'--''-�''----'-_ «- ' <br /> / <br /> Remvdelingond/o, nepa|,ing (deozibe) ----------- <br /> ---------------------------------------- -------- --------------- ---------------------------------------- <br /> ------------------------------------'-----'—'--------------''------------''----------- <br /> '--_--.'-''''''-''___-_--_-_-'_---__-'___'-__'__''_____-'''--'__- --'�''''--.'-_'''-'--_-'-' <br /> ' '------'----------'----'---'------------'-------------------'-'--------------- 9 <br /> hereby have prepared this application andthat the work will be done in accordancewith San Joaquin County � <br /> ordinances�. S�te laws, d rul s and regy i ns. of the San Joaquin Local Health District. <br /> (Signed)---- ------ ---------------------------------------------------------------------- ------ wn _an �actor) <br /> __ _7 es, �. <br /> (Plot plan, showing sidof lot. location of system in relation to wells, buildings, etc., can be PI on revers side). . <br /> FOR DEPARTMENT USE ONLY <br /> BU|LD|NG PERMIT ISSUED---------------------------------------------------------------------------------------- ----------- DATE-------- ----------.----_-_'----- <br /> Alteratons and/or recommendations:-''''_''-- -------------------------------------------------------------------------------------------------------------_------------ <br /> � ............... - ......... ----------------------------------------------------------------------------------------------------------------------------------------------------.--------------------------------------- . <br /> ---''-'-''''''''---'''-''''---'''--''-'---''''-''--'''''''''-'--'''--''''-'-'''-'-'-''---''--'------' <br /> --'--'--''''-''-'-'--'''''-'''—'''''-'''''--^'-''-''''----'''---'''--'''''''''''-''--'---'---' <br /> / . <br /> --''-''-''-''—''''--''''-''''--'''--''-''----'''''--''-----''''-'-''--''''''''''-'''''-'-''-'- <br /> - <br /> . � <br /> } /�' �� - c+ <br /> . <br /> FINAL |N3PEI�'|[>N BY��'- '-''^=''�}~,��'-'''-'''- Dot�------.-~.------- --- --------------- <br /> ) <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> ' <br /> /so South American Street am West Oak sfr°ef /oo Sycamore Street 814 North "C" Street <br /> k S+o"kf"". California' Lod/, California w°"te=°, California n~iiy. ,o°/m","ia <br /> ES-9 2M 10-52 Revised W-2100 <br />