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FOR OFFICE USE - <br />APPLICATION FOR SANITATION PERMIT Perm <br />........ This Permit Expires I Yam From Date Issued <br />Appkation is hereby made to the San Joaquin Local Health District for a permit to construct anci install fho work herein, <br />This application it made in compl;ance with County Or9% No� 549 <br />JOB ADDRESS AND LOCATION.... <br />Owner's Name, <br />Insfallation will serve- Residence Wakpartmen+ House n Commercial C] Trailer Court 0 Motel [I Other C1 <br />Number of living units: Number of bedrooms .Y. Number of bafhs ./_ Lot S;,, <br />Water Supply. Public system Community sysfern F1 Private Lij�epth to Water TablejOl 'ft- <br />Characfer of soil to a depth of 3 feet- Sand C] Gravel f -I Sandy Lciam 2,�tlay Loam f-1. Clay C] Adobe [:1 Hardpan 0 <br />Previous Application Made: (if yes,date... ............ __) No &' New Construction: Yes 2"e"IN-o C71 FHA/VAj Yes ED <br />TYPE OF INSTALLATION AND <br />(No septic tank or � �� �w°��&�~@�����w�� <br />. . . <br />--r'- T ^ ----` from n-~'`~ '-----Distanceloo el_r <br />-- - <br />CZ <br />Disposal Field: Distance from <br />nearest well. Distanco from foundati2n../y ....... . Distance to nearest lot line.4 7- ­ <br />Number -�� k <br />Type ofG�f�� nn�f�r�ui '��pH`�f�i+a�'m�tw�*L� _-T��� �m9�-'"�����--._.--_~� <br />Seepage Pit-. D7stmncp to nearest wolL'-..... ....... ..Distance from nomme+ lot <br />0 Number of pits., mafmrial Size; Djarnwte,. Depth ... ................ <br />__--_ <br />Qio�nmc from n�u,mv ,m��_-._~_ ���n�m Tn�m f�un6m+�o L��g mafur�| ^ <br />Cesspool: =^ - �\�---- ---^----------- <br />[] S�e,D�mu+e,--_-_-__.~_.-_`_��p+ -------- Liquid Capmdfy...... ___........ <br />.-gu� <br />p,ivy� Distance frorn nearest well.-.,,.,, ...... ' Disfaoca from *w*re^ 6uUJ;ng_-___~~...... -- <br />[] ^ <br />Distance to nearest lot |ine--_--_---�_-_.~~.,.���'-~��_ .� <br />. , <br />� <br />Remodeling and/orairing ���r��z_ '�2���*� .-_ <br />P, <br />....................... w� <br />-_-_-_--_--'---_............ _--__'---_.'_......... -... __---....... .......... --........ _-^............... -__........... <br />-'----'---'------- ---------�... ...... ------'------................. --------'r-'-- ... .................... ....... ...... <br />--~�� <br />this application and that the work will be done in accordance wK San Joacluin County <br />_-_-- State _laws, _and rules _and regulations - the San _Joaquin Local Health -__' ~ <br />__ Contractor) <br />(Plot plan, showing size of lot, locat[an of system �elii­ �-es etc, can be placed on reverse sidie). <br />FOR DEPARTMENT USE ONLY <br />APPLI,C-ATiOt4 ACCEPTED DATE_ <br />�_--' _____-___'--_-'_--_.___-__'-_-_--____'-__- <br />-__'-_-�-.----_-_'_'-__--_--_°�__._----._-__-_____-__-_----____-__',_-_--_'-'-_-_- <br />� <br />----__-_'----_-_-------___--_.......... ___-......... _..--_'-~_-__-_....... _----_._'_--....... <br />--__�_- <br />SAN JOAQUINLOCAL HEALTH DISTRICT <br />xsuvaw=°m=Avis, oomWoo Oak Street ,m*wv=rm°�r*u*=el mmWest 9th Street <br />staticto",Calw=ia Lodi, Col)fornla Manteca, Ca"fomila T*ocy, California <br />