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` CharacterPLICATION FOR SANITATION PERMIT Perrrjit No. --- -------- (Complete in Date Issued A licaflon i�ereb,y made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. his T i application is made in compliance with County Ordinance No. 549. ow 11_�;Lz F/1? ---------------------------------------------- --------------------- Installation will serve: Residence �Aparfment House E] Commercial E] Trailer Court E] Motel [:] Other E] Water Supply: Public system 91--communify system [] Pr ivate E] Depth to Water Table _�q ff. of ^~^ to ~ depth^ of~ '~~' ~~'~ Gravel E] ~~'~' Loa^' El `~a' / ~� rm '` / Previous Application^ E] No^ ~�~~' '=~ " u� =~ Construction:" '' ~"" ' '°" E] '" ' � TYPE Of INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available Septic Tank: Distance from nvoreo+ weU-.----Oistance from foundation--------------------Material ---------__--___ El N�. of compartments--------------------------Size--------------------------------Liquid d --------------------Cupq6+y_-----' Disposa| Fie�cl: V Distance from nnun,5f well------------------ from foundation '''-''''---Distance to nearest lot line-'----.. 1`71 y Number cJ lines-----------------------------------Length of each line------------------------------Width of trench -_-_----.-- ' Type oJf��r material-------------------------Depth of @+e, material --_�--.-'Total length---------------------------------- -'- Se~� ��'''' Distance to ne^,n;+ r - '~'^'~^~^ ''~3 � ''""-- D'^'a"�� +onearest lot /[n� ---- ' l� Number of pits----7 ---Lining mute'iui��.f -3|ze: Diom"+ec-a3---Depth ...... 1.�7___-_ Cn, ppn|: Distance from nearest well -_---Distance from foundation ------------------Lining mu1o6aiL- ----------------------------- 36e: Diameter-------------------------------------- '''---''-_.'''-'''''----------Uou|d Capacity------------------------_-gals. Privy: Distance from nen,n, well------------------------------------------------.Distance from nearest building------------------------------------------ El Distance fvnearest lot line '''--�-��'--'''-''''----------------------- ----------______________�_________ o6e and ° �� -_------_----'---- --''---''---__'--___-_'_-�__'_----''-__.'-_.-'__.___._-__...___.------___.._---------. __________________'________---____________'________'______''____________________________' . hereby , ordinances, Sfate_�ws, and rules and:regulations of the San Joaquin Local Health District. (Signed)- ~° ___._________ - ' ---------------------------------------------------------------(Title) (Plot p[an' showing size of lot, location'of system in relation to wells, buildings. efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY' /\PPL|CAT| ' DATE- REVIEWED BY'''- BUILDING PERMIT ISSUED___-��c�!-._--'_--_-_' DAT ------ Alterations and/or recmmmen6mfions:----------------------------- -___-____ --------------------------------------- -�-'-- ----------------- -------------------------------------------------------------------------------------------- '--'-'''-_------'''----''--_,._''_-_.'-_.-_.-�_-'-' -_-'--__- '' ---'---'—'--------'-------------------'---------------------' ----' -_----�----''''''--'-'-''-'',!''''-''''-'-''-'''-_-''--_.'''-'-'''-''''`,''''--'-''-'-'--'' �'-''--. '-''--''--'''''-''-''-'''-_-''''-'''-'''-'-'''--'''---'--'-''---''''--''-''----'''-_-'- _-''--- Du+o '--''-'''- - -'''-' '-''-'-RNAL INSPECTION 8Y:-''' ' t7w/ SAN JJAQU|NLOCAL HEALTH D|ST0CT /on South American Street amw°aOak s+°° mo Sycamore e=.* ow North "C" Street Stockton. California Lodi, California Manteca. California Tracy, California ' cS-'9-2w /0'52 x"v/^*d vv-2/00