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� APPLICATION FOR SANITATION PERMIT ^ �omn�� N° ^--`- Duplicate) Date Issued --. ---.. ' ' cJ hereby made to the San Joaquin Local Health District for u permit to construct and install the work herein described. This applicationis 6e in compliancewith County Ordinance N '.on�,uc�ur�� m�mo--'�� _'zm�ce��.-.-----------_--.-.-------- r�oneq��..x�.-..x.m�'��..x.. ' ---- Installation will serve: Residence Ot~/\parfmeof House [] 'Commercial [] Trailer Court 0 Motel [] Other E] Number ofliving units: / Numberof 6o6,00mo .A.. Number of baths -J- Lot size '~�� k'.��.8y^'��----------' � Wmter Supply: Public system �� Commun|ty system [] Private E] Depth to Water Tu6|u .Y4 ff. \ Character of soil to m depth of 3 feet: Sand Gravel [] Sandy Loam E] Clmy L am [] C|uy [] /\6o6aB~~H�,dpon [] ~ ' ~,�. Previous Application K4m6e; Yes �� No �_�' mew Construction: Ye, [_] No TYPE OF INSTALLATION AND 8PEC(Fi[AJ|[>NS, (No septic tank or cesspool pw,mi|fw6 if public sewer |^ available within 200 feet.) ' 3 k Distance from nearest well .----..Distance from foundation-------------------Material ----------___---.- ' No. of compartments-------------------- .....size--------------------- --------Liquid 6eA+k--------Capacity------.-- ^ Disposu| Field: ` Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-.--__ E] � Number oJ lines-----------------------------------Length of each line_-''-�''-''-'\�� oftn�ch'-'_'''---___ Type of G| | u� 3eepaV Pit: Distance to nearest well---'-- to | ----------------- Pr �_ n ° Number of p��--/----Uning c.--�4.^ -Depth- ----. Cesspool: Distance from nearest vm|L_'--' n --''_Uning ` mu+or�L-'�-��----'- El Size: Diameter----.---_ ----------Depth----------- ------------------ --- -----------------Liquid Co9ocity'-_.--_--go|s. Privy: Db�anco from nearest well--------- from nau,esfbuilding''---'----.'----- E] Distance to nearest lot line-------------------------------------------------.'_--''----'''-''-''--''-'''--'-''-'-� komo6o|ing mm6/qr repairing (describe):--''--''--''----'''-__'---'''__.-----_--'-_''-_._____'_________ ---'---'---'—'------------------'--------------------'---'----'------------ - -----'---''''-''--------''-------'----''--'-------'---'----''--'------''--'---------- «k ------'_-----_---___---------------------_---_------'__-----------__--------_---__---------- ----------------------I_�---'�_--__------'------'_-----------__---_----------_--------_--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ,-"_-, pl ---._-----._ Contractor)- _ - �.__�-_�__---~_��__.-__��------''-_.--__'''_-'''`--'-'---'-''-------_'---'---� (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc.^ can be placed on reverse side). FOR DEPARTMENT USE ONLY REY|EVVED BY------------------------------------- . DATE !�i ^-� ( ] ' -- ----------- -- '--r------'- BU|LD|NG' PERMIT ISSUED._-'--- `�---''-'--.'-_--.-'__'-_.'---''-- D�TE_-''---'__--''---'______ --------- Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------''--'''-----'-'-' '-------'--'-------'------'------'-----'--'-'-'---------------------- ____________________________________________________________________________________�________' _______________________________________________________________�_�_�__�________________' ^^ �~- F|N/\L INSPECTION 8Y�-----'�---.��.��./�/[��----- Date----.---.�--�----^,.�7-------------------------------- . SAN JOAQU|N LOCAL HEALTH DISTRICT /30 sv"m Am*o*= Street 300 Waif Oak s*,°^* /ox sv="m"re emo* 814 North ^c' Stme+ Smv"kf= Calao,"/° Lodi, California Manteca, California Tracy, California y ES-9-2M ; xe.im6 W-z|no /