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� <br /> � <br /> APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <br /> Date |amxyd "/ <br /> . e San Joaquin Local Health Disf,ict for upermit to construct anld ^install the work herein described. <br /> This application is made in compliance <br /> Owner's N <br /> 12 __ - __ __ ______ -------------------- ---------------- <br /> Installation will serve:(Resi'den'ce All nt House E] Co mercial Trailer Court [I Motel E] Other E] <br /> Number of living units: --- --- Number of bedrooms <br /> .7.--Number of baths j--- Lot size ---- <br /> Wafer Supply: Public .system El t Community system El 'Private x Depth to Wafer Table x . ­ , - <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam [] Clay Loam E] Clay [3 Adobe Hardpan El <br /> Previous Application Made- Yes [:1 No New Construction. Yes El 'No <br /> TYPE OF INSTALLATION AND SPECIZATIONS: f !," <br /> (No septic fankor cesspool permitted if public sewer is,amvla-ilable wifhin�200 feet.) <br /> �Septl T nkK: Distance from nearest well----- ----------Distance from foundation--------------------Material <br /> i'Tosal' Fiet1d <br /> i posal Field Distance from nearest w J1 [09._.Disfance from f<)uhdatibn�,�-LO-'e-.-.Disfance to nearest lot I' <br /> Type of filfer materiak:.T__Tj�__Depth of filter ma�erial---IX.1--------Total length__� <br /> 64ee"pa�ePit: Disf a nc'e't-o-ne'a rest well----------------------Distance from foundation------------------- Distance to nearest lot line <br /> ------------- <br /> -------------- <br /> Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------- gjals. <br /> Eli Disfance'to'nearesf lot fine----- <br /> ----------------------- <br /> --------------------------------- <br /> e inq and/or repairy' g.(d "Z <br /> °'0~ � <br /> I hereby cerfify-fhat I have.�repared this application and that the work will be done in accordance with San Joaquin Counfy <br /> ord'inances. State laws, and rules:and regulations of the San Joaquin-Local Health District. <br /> f If <br /> (Plot plan. showing sixeiiAh.t, llocafic�n of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------- <br /> REVIEWED BY LF------ <br /> ~~'~~^`^~ ' `~""'' ISSUED 0 --_----'�L.--i-�-.' D�TE-' 0 �� ~ '' ^ ' <br /> A�e, t�n" an6/mr ,e�nmmmn6at�ns�-,-. xx--,.----��--_-_---`-� '-.--.^--_'- _--_---'----------'' <br /> '--'----.---'''--'-'-''-'---'�'-''''-'''-''�-''-''''------'''-'''---'---'''-'--� ------.'_-_ <br /> ._-__----__-___------------'--------_.__'__.---------'__._----�-__.__.-._' <br /> _'--_---'''---�'---'''-''''-'--''-'''-'''-''-_'''__''-'''__---''-^-'--''-�'_-- ^ <br /> ' -------------------------------, <br /> _-_-'-----''''_'-'-''-'''-'-'-'-----'_-.''-- <br /> . ` <br /> HNAL INSPECTION BY:--->Vz:�6p19 <br /> --. Do+a--' .. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> oo South American Street 300 West Oak Street //z sv"a=*m emo» 8/4 morfk ^o^ Street <br /> Stockton, California Lod(. Ca|aCIm/* Mwn*co, California 7mov. California <br />