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FOP,OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />--------------------------------------------------------- <br /> . . <br /> ~~ --~- -- --' ~�- ����o&�� 0n // <br /> ________---------. ^--,-- ~_r^~-'-' �Do�� |v�e6 .......................- x <br /> Application is hereby made to the San J?aq�,,r�qcal Health Dist rict for a permit to construct and install the work herein described. <br /> if <br /> This application is made in complian, h *40rdinance No. 549. <br /> JOB ADDRESS AND LOC IOU_ <br /> 77- 1 If <br /> Contractor's Name--, <br /> Installation will serve: Residence Apartment House [3 Commercial F] Trailer Court E] WoNlID Other El <br /> Water Supply: Public system E] Community system F <br /> Private ET�'Depth to Water Tablek ff. <br /> Character of sail to a depth of 3 feet: Sand [] Gravel [] Sandy Loam E�`Clay Loam [3 Clay [3 Adobe Hardpan 0 <br /> _ Previous Applicationyes,date:-------------------- No New Construction Yes __ <br /> TYPE OF INSTALLATION AND SPECIFICATIO�S: <br /> --jNo septic tank or cesspool permitted if public sewer is available within 200 feet.) -V <br /> Disposal Field: Distance from nearest well___1----C".-Distance from hfoundation.-.4xj�zr� Distance to nearest lot ling................. <br /> fl- <br /> .`�""=� ", ".=�. == "=.*". ". ��". ".=_+*_=. _ <br /> Seepage R+: Distance to nearest well �-''----''Distance from foundationnearest lot line------' \ <br /> [] Number ofpits----------------------Lining material_---------------- Diameter.............. ........Depth--------------------------------- <br /> � . i <br /> Cesspool: Distance from nearest well -_ <br /> .. . D|� from om fvun6u+� - <br /> foundation------ <br /> . ng material --_-_----- <br /> 11 Size: Diameter'''''-'--'''''.'-Daotk_''',''''-__'''—_-''__Liquid .......................... <br /> Privy: Distance from neo,00 well-------------------------------------------------Distance from nearest building-___'--__-_-- <br /> [] � Distuncatunounmt |uf |ime------------------------------------------------____---'�-�.. --..--------'___--_-- <br /> Romndoing omJ/o, repairing ---------------------------------------------- <br /> .......................----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- -------------------- <br /> --- <br /> '-------------'--'---'--''----------�-'----------------''---------'---'--------' <br /> -----------------------------__.----------------------- ----------------------------------------__...__-.._-.-____..-_--..__-__..___L_..-`._------ <br /> | hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and rmgulaflwnm of the San Joaquin Local Health District. <br /> __.._ ------------------------------------------------------------------------------------------------------------------------------------------- and/or � <br />. By:--------------------------------------------------------------- ------------------------------------------d----------------------- ---------------------------------------- -------- ''--- <br />` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------- <br /> BUILDING PERMIT ISSUED. DATE <br /> / x <br />- <br /> SAN JOAQUiNLOCAL HEALTH DISTRICT <br /> vwwSouth American Street uowWest Oak Street 124 Sycamore Street 2waWest nmStreet <br /> Stockton,California Lodi,California m te"m.cu/n"rn/a Tracy,California <br /> "° 9 "".."m =°p "p °'^. ^,u" ~� � <br />