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FOR ' <br /> r`—'—����/]���������� � > <br /> '� ' )- - ' --' -'-' ' FOR SANITATION PERMIT� Permit Nd. <br /> � ` <br /> - ff "�^ �n \ <br /> ~ 'This r°°'ple'~ ~~r~~'~/ Dm+a �ouod -��!�����' <br /> dto the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance wit r, rclin�a N o,ZI <br /> Contractor's Nomn-- ----------------- <br /> Phone----------------------------------- <br /> Installation <br /> . <br /> Trailer Court [] Motel [] Other [] <br /> Wafer Supply:. . -- Community system -- Private~ -- Depth to Water To <br /> ble ' ^. <br /> Character ofsoil toadepth of 3 feel: Sand [3 Gravel E] S6m4yLoam Ej Clay Adobe[] Hardpan C] <br /> Previous Application k4m6e: (|{yes,date----------- --------) No 2.^�Iew Construct ion: Yes [n'No El FHA/VA. Ye, nc*�No [] . <br /> . ~ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted R public. is O b|e within 200 feet.) -- <br /> / <br /> Septic k: Distance 6o U Distance <br /> ------- <br /> No. of mn m� �— o/�����. <br /> . i t +�u � +^ *a nmun,^� /u* xno �eDi, | u|6� Distance {nbm - U Ds <br /> Number o,=/ � _ ~ ~ �engm cn �^��nx—nn--^—^ ,="—". " -----'' <br /> ' ---- ='-- - ----4 .'p" of ° /'=~''a * ~~r^' ~' filtermaterial <br /> U <br /> [ <br /> ^ <br /> Seepage Dist ell------------- Distance + <br /> >^ Cesspool:poo|� Distance-, f6o�'*eun,�.wn| Di�anco �o�Joun�mt�o-- -_- U | <br /> Size: Diameter------------------------------------- idLCapacity................... --------gals. <br /> w <br /> ' Privy- Distance from nrn,=s nou*,,tpeU-��''--�'��''-_''--'�-D|�uno, f��`` building-------------------- <br /> E] Di�� +o r�� ��l� <br /> [ ' <br /> Romo6oling and/or repairing (describe):---------- --------------------------------------------- ''-_---_-- ' <br /> | <br /> . <br /> --------------------- ---------------------------------------------- . <br /> .___ -'_.---._____--'�---'-___.___._-_------` �� <br /> .----_._.--.—.--__-_`�_..`_--_----._'___-._--__..__._----__.--'''_-_____-_-- <br /> - ---- � <br /> ` ` <br /> | —'' -__-''-'''-''-'_------''---'-'-�'''--'---'----'------''--''---''------''----''-''----'—' <br /> \ ' her---' certify -- ' have prepared thi-- `application and that the work will be done in'accordance with San Joaquin County <br /> / "."".".~�~ °.".� la*o and ~.J .~�~laMwno oftho`Sa. Joaquin~ Local H.-KhOhf�ct <br /> ^ �~ <br /> � <br /> (Plot plan. showing size of lot, location "of sys-. �_in relation to.wells,. buildings, efc.,.can be placed on reverse side). <br /> —~- FOR DEPA,RTMENTUSE ONLY ` <br /> --- - ----- --------41?,�------------ -- -- -- -- ------- - ---------- - ------ <br /> ' ' ^`'`^ ^`~ ' <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street uuwWest m"k` ^� i ` � �1u*Sp�~"�v�e, uwwWest v��,"� <br /> Stockton,California Lodi,California wa°,°°", <br /> California Tracy,California <br /> =."""~."""°."",.""",`" ".," <br /> - <br />