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� ' APpL^CATION FOR SANITATION �nn� N� _.�� . ~ ~ ' ��mo�� � ` -'- Duplicate)- ` Du+o Issued ' -------------'-----'/' -- . Application_ - hereby_ ---- _ -o San ...,... ^.`.. . .... District for o permit to construct and install the work heroin described. .Thisapp|icationlsmade in compliance with County Ordinance*No.. 549. 40 ^ � -- ^� |n�aU�� v� ��; Residence �� Aparfmnnt House [-] Commercial E] Trailer Courf []_ Motel Ej Other E] Number ofliving units: _ �. Number ofbedrooms \3.- Number J - �__-_-' �� Supply: Public system E] Community system -E] Private Depfh foWater Table 33_ft. ' Character of soil to m depth of 3feet:' � dGravel E] Sandy Loom [] Clay L� E] C|uy.D Adobe Hardpan E]Previous Application Made: Yeo E] No � PNew Construction: Yes El No . TYPE OPINSTALLATION AND SPECIFICATIONS: (No septic tank or co,apno| panniffoJ if public sewer is available within 280 feet.) Sep Distance from nearest well .-k,'�(---Distance �Z4Au)-MJ � � .No. of compartments--------- ---Size-E ' � Liquid dep+�--..�e.,---'Cupa�+y- � � -- Dis � / , ' 6: Distance fro |-----�� Distance from foundation-----q�C? ��' Num6er of lines ��' Longiof each |i Type o{ fiKor mnferi«|_m��.Deot of filter material-_4-1------------Total length--------18b/---___.. 3ccpage Pit: Distance to nearest well -------- ---------Distance from foundation--------------------Distance to nearest lot line Number ofpits-------------- -------Lining material -._-_.-Siza: Diameter�----.'-_Depth---_-_.___ � : Distance from nearest well -��---'-Distance 6om foundation-'''_'---Lining mn|yrioL'-_--`'-_-'-'__ [] Size: D�omefec.------._---. Dept h----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ''��-'''__-'_--_.- [] Distance tunearest lot line------------------------------------------------- -------------------------------------------------------------- N ' - Remo6e|ing ond . n:puiring (6emcribe):'--- '_ _____________. '____--_________. ------------'------'--'--------'----'----`---'------------------'----------'—' -'-------____�_.-___-..__----_--___.--__._-____.--_-_-___.------____.__.-'_--'___.- --_-___-'___-'--'-'-'-'___-'-__...___--____-'-_._----__---_-_--__-._.--__------------- - | hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances.Afaife laws, an6r I s and regulations of the San Joaquin Local Health District (Signed) ^.-. �� ^ .."'-- ----.- ---------------------------------- u Cnn*a6uA . By:.____'....---------------------------------------------------------------------------------------------------------------(Title)---_----__.-____--____ - (Pof plan, showing size of lot location of system in relation to *aUu. 6uikJings, etc., can be placed on reverse side). / FOR DEPARTMENT USE ONLY ,-. REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------- ;L9 ------------ Alterations and/or ,000mmnenJuions:-------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ --------------------------- �---------`-----`------------`````-----``-------```-----``� -------------`---`-----```-------`--------``````-------`````----``--`-----```-----------`----------'-------`---``------ --------------------------------- -----------�'��'��'��'��'��`�� . . -�'--'-''-----''''--'''-'''----'''-�''��_�-�''-'--''''''---'''--''---''''--'''-'_--''_----_.''-- / RN/\L INSPECTION 8Y:---- ---------. Date . / SAN JOAQU|N LOCAL HEALTH DISTRICT mo S""m American Street amWest Oak Street oz Sycamore Street o/+ N"rih "C' Street \ ' St*"H"". California Lodi, California Manteca, California naov. California ES-9-2M &51 R^./"o6 vv-2/00 `