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ox <br /> APPLICATION FOR SANITATION PERMIT <br /> � <br /> � <br /> (Complete Duplicate) Date Issued' <br /> App|ico+|on is hereby made to the Sun Joaquin Local Health Dis+rict for a permit to construct and install the work her in described. <br /> This application is mode in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND _.. <br /> --------------------------- <br /> ----------?___ V <br /> Installation will serve: Residence IN Apartment House E] ornmercial E] Teailer Court E] Motel E] Other 0 <br /> Number of living units: I------ Number of be< ViNumber of baths I---- Lot size ......5700--p-?t!�----/J-A!----------------- <br /> Water Supply: Public system ;< Community system El Private 0 Depth to Water Table A/411ff. <br /> Character of soil to a depth of 3 feet- Sand E] Gravel [:] Sandy Loam El Clay Loam El Clay E] Adobe Hardpan E] <br /> Previous Application Made: Yes E] No U( New Construction: Yes 0 No E] <br /> TYPE OF INSTALLATION, AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) <br /> D|s+uno, from nearest well-----------------Distance from foundation-------------------Material ---.----_—_------ ---- <br /> No. of compartments--------------------- ----Size-------------------------------Liquid 6up�h--------------------------Capacity--___.— <br /> D|�un�o �om no�ne� °eK'—'—------Distance 6nm foundation--------------------Distance to nearest lot line---.--- <br /> ^~~�� Number ,f lines------------ of each Unn`.____----VVidth of �onch---_-_--._— <br /> Type of filter material ---- ------- ---Depth of filter material —.--._—Tofa| |ano+h-----------------Seepag � <br /> � � <br /> " Distance to nearest | | � <br /> oH+: u�+u to well-J-4-0-KO` u�an <br /> lumber of pits &joul ---Depfh--A-X------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------------- Lining material---------_—._ <br /> [] Size; Diameter.—_----_--.—Depth_-------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nvo,e, well—��--''---''''�'''—''Distance from nearest building------------------------------------------ <br /> F-1 Distance to nearest lot line—_-----_--.-----'__..__.___.__'—_--_______________ <br /> Romo6elingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------'--''--''--'--------'-------'----------'------'-'--'—'---' <br /> --------'-------------------''---'----'------------'---'-----''--'-------''''—''-----' <br /> ')fia+ the work will be done in accordance with San Joaquin County <br /> I hereby certify the I have prep red is application and <br /> Ify <br /> ordinances, Stal nd rul and eg altions of the San J quin Local Health District. <br /> (Signed--------_----- ---P6_,.)A,1 - ----- ------------ ----------------------------------- - ------ ----- ------------- ------- <br /> Wvt Contractor) <br /> o wells, buildincs, <br /> (Plot plan. showing size of lot, location of system in relatio e b. ings, 1c.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> AKarm+ionoun6/o, ne*ommpn6aGqnu---'_—.--_—_-----''---_-_--.._________--_____.______.____.. <br /> ----.--_'—'---''_—''—_.''—_.'--_''-'—'----'''--''—__-'--_.-'—'''''—_—'''--------__''----'_—_----_.. <br /> ----------­­ <br /> ----------'--```-----`--------````-----``-----````----`�-------``---------``��----`---------`-----------`----------``------------------``----------------------``---`` <br /> ---------_------_- --------__------------.—_--'—_--_—.—.. <br /> / / ~� �� <br /> V ~���� � /F|N/\L |NSPBCT|[)N BY:----------------------------------------------------------------- <br /> SAN <br /> Dmte------'L----.------------___. <br /> SANJOAQU|NUOCALHEAOH DISTRICT <br /> /s* Som* American Street 300 West Oak Street /az Sycamore Street 814 North ^c:' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-11-2M x°"a"a W-o/ou <br />