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' APPLICATION FOR SANITATION \ Permit Mo. <br /> �� � <br /> (Complete in Duplicate) ~ ^� <br /> ^ 3~ \ Date |mmnd �~ <br /> � . <br /> herebyApplica4-ion is <br /> made to the San Joaquin Local Health District for o permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinancp N,o. 549. <br /> et <br /> Contractor's Name-- <br /> Installation will serve: Residence Apartment- ouse Commercial Trailer Court 0 Motel [] Other El <br /> Number of living units: ___/--- Number of bedrooms Number of baths __/---- Lot size .....T----- I------------ <br /> ' Water Supply: Pu6!ic system El Community system El Private Table _40. ft. ~ ' <br /> Character of soil to a depth of 3 |..- Sand [] 6mmy El Sandy ---m)o�` Clay Loam [] Clay 0 Adobe E] Hardpan [ <br /> Previous Application Made: Yes F] No'Eq New Construction: n El <br /> TYPE Of INSTALLATION AND SPECIFICATIONS: <br /> (No uwpGcfa k or cesspool permitted if public sewer isavailable within 20.0 feet.) ^� _ <br />' <br /> Septic Tank- � �--ncu f,o .--oureo+ w°U �-&- , ~m <br /> `~ . qwi6 6� !�- . � �� � 'Capacity � .� �~�.- <br /> 'No. nfcompor+munb- --._-..6ize.� 'X"SD .2 <br /> ~� � / <br /> Disposal Field: D� c � � <br /> `�x Number of lineseach � oft,e --- <br /> ^ »� <br /> �� <br /> Type nf �|to, m*ta'����t:��\ �.� �|fvr mof��oL� e�.--.-7o+u| |enof�-_.,/ �� ��__.- <br /> 6--- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number ofpits----------------------Lining material----------------------- Diameter._---.--De-pth----------------- ---.- <br /> Coepnn|: Distance from nearest °vL_---Distomoe from foundution------ Lining material _--.—._--_- � <br /> ' [] S�ze: Diameter--'----'''---''—Deof ------------------------------------ --------------- Capacity----------------------------gals. <br />' privy. <br /> ' Distance from nearest °ell—''---''-'''' ---------- .-D;stunce from nearest building--------------------------------------- <br /> ElDistance to nvo",s+ |o+ line-------------------------------------- --.__.�-----------`_--__—__------._---- <br /> Remodeling om�/o, repairing |6u�c����' '_-'--____-_.'_---'_-'__' <br /> '_._i.___-__'----_-__..-------_--`''-----^'--'---------'----------------''--'--------- <br /> ' . <br /> --''-'--.-'_-_--'--'-_-_--_'-----_---'-_-'-_-'_-__.-__--__-'__.-_-�.--''---__'-_.'''_-'''��--' <br /> . . <br /> '-''----'-----''-----------'''---'-------'-''----''-----''--'-''----'--'--'--'--'-'----'-'-- <br /> � hereby certify that | have preparedAis application and that the work will 6eAcine in accordance with San Joaquin County ' <br /> m,6inwnoos. State laws. and rules and regulations of the San Joaquin Local Health District. ^ <br /> ���na61- -------------.---'^----'�0h°nm, and/or c�wn�amto� . <br /> ' ----- <br /> B -- <br /> -_--.-.-_---_--�T��1-----_----_-_-------- <br /> �P�� p|an. �z� uf �t |o���onpfsyvo,� iM�m|mt�� tn �wU� buildings,-etc.. �m ���m� �n�rev��e side). <br /> FOR DEPARTMENT USE ONLY � <br /> APPLICATION~ ACCEPTED BY <br />� uEv|EvvEu BY <br /> ------- <br /> ----------------------------------'------------------------------------------------------------ --------------------------------' --------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------'^''--'�-'�-''_'''''-_-''''-''--''--'-^'-__'''''--'''-'--'-''--' <br /> '-'-'--'_'',___.-� '''-''''--_-'--�'''_'''--' -'-''-'--'. <br />� . /~ �^ <br /> RNAL M4SPECT[nN-BY�'�-j��[���' —_-'-' On+o -''�-�-]LJL.1'_i'��-''--'__-''-'— <br /> ~ ' ` <br /> � SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> mn South American Street 300 West Oak Street |sz Sycamore Street */* m**h "C" Street <br /> Stockton. California Lodi, California Manteca, California Tracy, California <br />