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� � <br /> APPLICATION FOR SANSANITATION�T� � ����[� Ponn� No. ����.�-��,, <br /> � omn|�� � " <br /> ^--' --,---/ Date Issued �°�����------. <br /> A _4' " h b ade to tfi�'San Jdaquin Local Health District for a permit to construct &n e work herein described. <br /> This application is made in compliance v�itb County Ordinanqg No. 549. <br /> ............ -- ------ ----------------------------------I------------ ......( <br /> Owner's Name r-------g---- -------- - ------- <br /> Address...............e,� .........f----------- ..................... ..................................................................................... <br /> Installation will serve: Residence Apartment HouseCommercial [:] Trailer Court [-] Motel [] Other E]� ' *��r <br /> Number ofliving units: .K-- Nwno6e, o{ bedrooms .��c' Number of baths j <br /> . �� �� <br /> �/ 6vr Supply: Public system [] Community system C1 Privorn�� Depth to Vv���r~r��|e .. -.^Ft_-'-~~~~^~'-~ '`^°�~-°�v' <br /> Character of m,U to a depth of 3 feet: 3unJ [] Gn,vo| E] Sandy Loam [] Clay Loam [] Clay O� Adobe C] Hardpan [] <br /> ,4� <br /> Previous ApplicationApplicationMade:�� Yes [] No �� New Construction- ��' �cfion� Ya, �� No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet,) <br /> Septic Tank: Distance from L�� <br /> --����--.'-.S�v-.- ��'������.��Liqvid 6 th ��^ <br /> �� No. of compartments C8_00 ' <br /> Dispo9 | Field: Distance from nearest weU.10.0----Distance from foundation ........ <br /> Di � - 511—p <br /> ...--' <br /> Number of lines- _Length of each |in�' �� :Z. _',*7 <br /> of filter mu+o�uLTotal T.L6-- <br /> -Tvon of filter materialSeepage Pit: Distance to nearest well --'---'_.-Distance from --_Distance to nearest lot line_- <br /> ^ (Plot plan, 'showing side of lot, location of system.in relation to wells, buildings, efc., can be placed on reverse side). <br /> -_ -------------- <br /> FOR DEPARTMENT USE ONLY <br /> �.- <br /> _-_- <br /> [ Number of p�n_-._'-_-_Un�g material----------------------- D�me+nr----- -'Depth'-____'- <br /> Cesspool: Distance from nnmn�t ~eL_-...._--Distancefnnn foun6u+�n---_''_-�^ing na+o�ai----'_ <br /> [] Size: D�motnc._------_--'._-Dwpfh....................................................L'yui6 Capacity ' --- -- <br /> '�_ -- <br /> gals. <br /> _ <br /> ./ <br /> Privy: Distancefnzm nearest ~o|L-''-__''- <br /> LJ D�fmncofonoor*v �f |ine'.-_--- ---_-_--'O�tance from nearest6v86�g-------------------------- ' -- <br /> -__________.______._.__.____________ _ <br /> Romo6w|�q and/or repairing �nec�6eJ�--''_-._- <br /> -- __'--__.__-__--___---'---___--_-__'-__'-----.----__.._-__-__--_-'_-_---__-- <br /> __� '-__----__.----_-'-___--___---__----___---__-'--___----.'-----_ --' <br /> -_-_--_''--_-___.-----_.-.__-_-_.--__------_-..-'--'-_-'__. -'| have ' the work w0 be done in accordance with San Joaquin � unfvo,d�wnc=p State laws, and rules and re9�a�nnswfthe San Joaquin Local Health Df <br /> ���L <br /> GAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /30 s""m American s*°a 300 West Oak st,°°+ /32 Sycamore str°°+ o/4 North ''o'' Street <br /> Stockton, California Lodi, California Manteca. California Tracy, California <br /> ES-9-2M o's/ xo./.°a vv'x/um <br />