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H , 4- APPLICATION FOR SANITATION PERMIT— Permit NA-4-74—.- (Complete in Duplicate) Date Issued A ion is here install the work hemi, cle,,6bd. T�plication is here yy made to the San Joaquin Local Health District for a permit to construct and 's ifh C f Ordinance No 549 Owner's Name-&--'C' ---- ----- I------------------------------------- ------------------------------------------------------ Installation will serve: Residence Apartment House [:1 Commercial E] Trailer Court E] M f I E] Other I L] Number of living units: ---I--- Number of bedrooms 3- Numb aths J---- Lot size ---cff-Z"x-1&--- ------------------------- Water Supply; Public system El Community system F te ��Depfh to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sanj4 Gravel EI Sandy Loam Ej Clay Loam [] Clay [] Adobe M/M/ardpan Previous Application Made: Yes E] No 5� New Construction; Yes [R/No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p IiF" wer is available within 200 feet.j_ � � A t j Q Distance from nearest well ------Distai1qei6orn foun tion-10-------- SepVank: Aat ill--- Dis Field: Distance from nearest well Distance from foundaVi n-- -----6istance to nearest lot line--- ------ Pe Number of lines-- Width of trench Z-f- epth Seepage Pit: Distance to nearest well----------------------Distance from foundation------ ---------Distance to nearest lot line---------------�N Ceoqpov|: D�stance from n:m,no well-----------------Distance from foundation--------------------Lining material------------------------------------ 1771 Size: Diametec'_—.''—_-'''-'__Dooth-.__'-''''__.''''''—_—'—Uqui6 Capacity----------------------------gall Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------- .... [] Distance +nnearest lot line_—_--__—__---._____.._.__--___.__-----_—.._—_.__-_—' ��w an�/or repai in (describe): f^,"-------------- '—'--'---------'------'------'----'----r--------'---'---'--'-------'---'---'--------'--- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o6he San Joaquin Local Health District. (Signed)----.rr----7124---- --------------------------- -- -------------- ------------------------I-------------------------------------------(Owner and/or Contractor) jPlot plan, showing size of lot, location of system in relation to wells, buildin'gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY AJtera6pnsanJ/p, rmnommen6ations:-----_--_.--_-------.___----___—__--.__--.___-___.-__-_.___ -------------'--------'--'----'-------------------------'---'--'----'---'''--------- -__.—__—__.-__.'-__—''''___---__—'''--_-''---_-_----__'--____—__--------_—_---___-__--_ '—_—____-__---_�_—_-._----'_--.__—_._---.--__—.—_---.__—__._.___-__—_-___^__ --`--'-----``----``--'``----```--'-````--```-----` ----```---```-------'``----```---``---'---``-- � �N/\L INSPECTION BY:------------- D*+m_--� _..-`--__._--_-- ^ ` . / . SANJOAQU|NLOCALHEALTHD|STRIC7 130 south America" street 300 West Oak street 132 Sycamore Street ow ^orfh "C' Street Sto"kto", California Lodi, California Manmca, California Tracy, California ES-9-2M o'o/ x°"/=d vv'2/00 `