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APPLICATION FOR SANITATION PERMIT Permit No. __73.q�---7--- <br /> (Complete in Duplicate) <br /> ' <br /> n is hereby made to the San Joaquin Local Health-District for a pf�rmit to construct and install <br /> ^ inaro.m � <br /> -- -/ / ~ <br /> Installation will serve: ResidericeK Apartment House E] Commercia.I E] Trailer Court E] Motel El Other E] <br /> Nurhber of living Number of bedrooms -3--- Number 6f,baths __/--- Lot size __7S7K---2-7e <br /> Wafer Supply: Public system E] Commun�ity system E] Priva te Z Depth to Water Table -------- ff. <br /> Character mfsoil foadepth 6f3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [] Clay E] AclobeZ Hardpan [� ' � <br /> Previous Application Kxm6e: Yes E] No'E� New Construction: Yes [] 'No FHA/VA. Yey [] N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'ne,� mo| permitted ifpublic sewer is available wifkin 200fewt) <br /> � <br /> Septic Tank: Distance from-.aure`+ ------Distane from foundation //O Material <br /> Nn. ofcb�npurtnen1s__..._'._1_� -------------Size-.. _Liouid 6epfh----------f� ---------Capacity------ 111,00----- <br /> Disposal <br /> .'Di, | Field: <br /> ' 'Distance from nearest welL `-�5­4��....Distance from fomndof|m��-/ .'--Dist*ncu to nearest |o| |i / <br /> . . m/=rm*r;rm <br /> , <br /> Type v . er materiaf-` -----------' -----Total length------------------------------------------- <br /> Se R+:� Distance to nearest ��|,��/������D/�o�co �on�foundation---'^/Q--------Distance to nearest lot <br /> ' � . <br /> �||uv`._� <br /> est <br /> Num6erofpO�--.��-_�i�ning m Diomv+oc.�� --Deofh'_ /���''_--.' <br /> ----------- <br /> Distance n°urwv '--'-Dfmn� � �^ nCesspool: cn � -'_'--LiningmoforiaL'''-'-_-'--_ _. <br /> ' <br /> [] ' Size: Diameter----------- ---------------------------------------------------Liquid Capacity--._--'-_-gm(s. <br /> Privy Distance fr'om ncoreu well-''''''----''�-��-'-^Distance from nearest building---------------------------------------- <br /> Distance <br /> '-'''--'-____-'-Dist nco ho neon,s� lot |ine.'..-----_----____.________.___________.__.__._____� - \ <br /> . , <br /> ' Rvmo6eling and/or nypniring (Jescribe): - ---------------------------------------------- --------------------------------------._-'_-'--_'-_-'--.-'--''-- | <br /> �.__'--._--_-_^-'__-_-_--__-_._------------''-_^.--'-'- <br /> '--'---.-_''-_--_---------.--_.'I-------------------------------------------- . <br /> ---------------------------------------------------- __-. <br /> hereby <br /> ill <br /> certify that I -have prepared -this application--- -and that the ~~~ -^ ~~ ~~~ ^' ~~°° """^= —" S=" Joaquin County ' <br /> State laws, and ru les and regulations of the San Joaquin Local Health District. . <br /> ~~ <br /> p' ---'----- ------------------------------------(Owner and/or Contractor) <br /> ' -''''-__'--'-_.' ------------`...-'---''-'--._-'-_.'__''-'-'-' ` <br /> (Plof plan, showing size uflot'k/catiun ofw0em in re|atinn +mweU» buildings, otc., can be placed on reverse side). <br /> � FOR DEPARTMENT USE ONLY / <br /> REVIEWED BY-------------- DATE----------------: <br /> ----------- -------------- --------- --- - ----- ---- ----- - -------- --- ----------------------- <br /> E I <br /> .-.--_-_._-____.- ----------------------~�____-_.__-._.._--_--_--_-_-._._------__--__-- <br /> , ° � <br /> '-'--_.'_--_--_.--''----`,'-'''-''-_'_--_----'-'--'---'--'''--^''-'''---'--'-','-_''----'--'---' . <br /> _._-_--__.-----..--.- _� ----_-_------------_------._-_-------------_- . <br /> � ~� �� _~_ <br /> HN/\L |N6P8CT|[)N �_._.----�_--'-'`-'-- -Doto..��-~-^--^y-��---��- -'`----_.- <br /> SAJN JOAQU|N LOCAL HEALTH DISTRICT <br /> /mm South American Stwof mm West Oak Street |:x Sycamore Street v|* North ^c^ o*"e+ <br /> Stockton,.California Lodi, California Marta", California Tracy, California <br /> es-9-21A m=a°d 1'5rrco ~ <br /> �n� � ! <br /> ' - <br />