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APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicate) <br />Dote Issued <br />�ppkcot�n ishereby made to the San �District for a pennpermittocons�vc+ and install the work herein described.. <br />Tk� application" compliance �n com��ncn wit6Cvvnty {}r6inonom No. 549. <br />JOB ADDRESS AND LOCATION ----------- $u/�,��--- ��-- _.-.---'---------' <br />' <br />---------------------------_- 1?!z z_�� - <br />^ <br />Contractor's Name <br />, -------'--_'''-- Phone <br />------------- <br />Installation serve: Apartment House F] Commercial [] Trailer Court [j Motel [] Other [] <br />of living units. /-. Number ofbedrooms --- /- Number of baths »'.. Lot size ------- ~���-.��'^����Z..^----.- <br />V i <br />Water Supply: Public 5�m � Community system � P�� � Do�� ��r��o 'r�� <br />�� ~` � ~- <br />Chamcter of w@ to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam[] Clay El Adobe -~ |� <br />/Hu��o [] ~^PreviousApplication Made: Yes [� ,.1[Now Construction: Y�` FHA/VA. Yes D N <br />A�VI �1 <br />TYPE OF |NST\LLAT|ON AND SPEC|JONS� ' � <br />/N* septic tank o, cesspool permitted if pu6licsewer isavailable within 200 feet.) <br />' Distance from nnun,dweU------D)stunce from foundation --------------------- MateriaL------.---------- <br />» No. ufcompartments -------------------------- Size ---------------------------- --- Liquid 6ep�h-------------------------- Capacity ._----_ ` <br />kd/ D�stunco from nearest well '--''- Distance from foundation ------- ----------- Distance fonearest lot line ------------------ Xr <br />" Number of |inos ----------------------------------- Length of each |i ------------------- Width of trench ----------------- '---''''�1W <br />Tvn"- of -- material --,-- filter ---`-'---' Total <br />-'�''--'-'''--''-----­r0 . <br />Seee Pit' Distance to neo,r; ��|_ ..Distance_-��u' Distancpjo nearest lot |[ne="1jT0- <br />1�| <br />Number of pits --../ -----.Lin|ng material J�e]D�omofoc_- !�^�.. Depth °a_?_4 -------------------- <br />Cesspool-, Distance Dist nce fn»m nearest well ----------------- Distance from foundation -------------------- Lining material -------------------------------- <br />F] Size: Diameter -------------------- �_--.-Depth ---------------------- ------------------------------ Uqui6 Capacity ---------------------------- gu|s. ' <br />Privy/ Disfancu from nearest well ------------------------------------------------- Distance from nearest 6uiWinq_---_._._.--.--Vm <br />F] Distance to nearest lot line '''--''''-''''-'''----_'-'-''-_.-_-''_=�_-'-'-''-'--'''_-'-'' <br />------- <br />------------------------------- --------------------------------------------- ------------- -------------------------------------------------------------------------------- _.---------_' ' <br />ha*e . ^ <br />ordinances, State laws,,and rules an d <br />reg <br />��nod� *�x-z� �� ,r6ns of the San in Local Health District.^ <br />(Plo+plan. showing size of lot, location ofsys em --in relafion to wells. build ,, otm, can be p|aumJ on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY DATE <br />` <br />------------------------.. ----------------------------�-------------.------ .. <br />/ �'��/��� <br />HN/\L INSPECTION BY:---.L^i�L�I���-----��-�---. Do+o-'�-��l..��- ----- L��/��----------- <br />SANJOAQU|NLOCAL HEALTH DISTRICT <br />130 South Arner!"o Street 300 West Oak Street oz s/=°m"= Street ow North "C" Street <br />Stvkfi".Ca|Uo,"io Lodi, California Manteca, California Tracy, California <br />' <br />k / <br />