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� <br /> ^ ' APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> , Date Issued <br /> r 'Application is hereby made to the San Joaquin Local Health Disfrict for a permit to construct and install the work herein described. <br /> ....eThis application is made in compliance with County Ordinance No. 549. <br /> Installation will serve: Residence arfment House E] Commercial xr E Trailer Court -- Motel El Other <br /> �r <br /> Number of living units: =�,�v?,-- Number ofbedrooms .~-���. Number of 6o+h, .;Z- Lot size �� .. �� �y.��--.-----' <br /> ' Water Supply; Public system El Community system Private E] Depih to Wafer Table 35ff. <br /> Character of soil tom depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam Clay AdobeX Hardpan El <br /> i Previous Application Made: Yes [] No9 New Construction: Yo, g No F-1 FHA/VA-. Yes E] No E] <br /> TYPE OPINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) <br /> S tic Tank: Distance from nearest well----------------- from foundation---------------------Material <br /> ------------____ <br /> No. of compartments--------------------------Size--------------------------------Liquid 6epih--------------------------Capacity---.----- <br /> Fi : Distance from nearest wcU-----------Distance from foundation------------------- Distance to nearest lot line..... ----------- <br /> Number of lines---------------------------------Length of each <br /> Un*-''---'''-_._VdH` of trench ' --_ <br /> Tvn� length <br /> of m�t*h�| Depth of ��m �oL �no+ <br /> Seupuge Pit: Distance to nearest <br /> � ^ . � � ^ <br /> m� cUK Number of plfu----/---.L�ing material 3|=a� Dio � -� . ~-�_ <br /> |: <br /> Di,h,noo from nearest mofa6oL--._-----_'_- <br /> ~~^ ' F] Size: Diamv+ c.-''''-'''_'-'-Deo+h---------------------------------------------------Liquid Copodfy'--------------------------gals. 0\ <br /> Privy: Oidonoo from nearest well �'--'-'-'--''-'''_.Distance from nv°resf building------- '''__.'__.--- ° <br /> ` [] Disfanco to nearest |o+ lire ____________._________� � <br /> Remodeling and/or repairing (clesc6be) <br /> --'--'-------''--'-'''-'''----'-----''---'-----'-'---'---�-''--�--'---''---'�''--t�-''----''-' <br /> -_-----__---.--_---------_-_.-_-_-.--___-'---__.__-__-__._:--------------------------------------------I hereby certify that I have prepared this application and fhat.fhe work will be done in accordance with San Joaquin County <br /> ordinances, St law 4nd rules and re I t, off fThn Sa Joaqu, Local Health District. <br /> ----------------------------------------- _; -W_ ,K <br /> ° <br /> (Plot plan. showing m'' of lot. location `-Sy +-� - ---re a ;on to wells, buildings,— --` can be placed on reverse ~~~� <br /> FOR DEPARTMENT USE ONLY <br /> i A---- - ------------------&------- ------ <br /> tAll fT e r a fT i o n asnd//; e im7endXa --- ---- - - -- ------- --------------- <br /> _RNAL N Df - �� � �� &- o ------------------- <br /> ------------------- <br /> SAN <br /> _- <br /> SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> /*v s""m American Street wD West Oak Street 132 Sycamore Street 9/4 North ^C^ s*w° <br /> a""kt" . California Lodi. California Manteca, California Tra"y, California <br /> ss-9-2w n°./,"u 1'57 p,p.on� <br />