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� <br />\- <br />APPLICATION FOR SANITATION PERMIT� <br />~ <br />�� <br />(Complete in Uupl�m�� <br />' <br />' ~ <br />hena6v made to the Son Joaqu�n Local Hro�h Dkfr|cffor o perm�tocondmcfon6 ino�hereinthe wor heredeoc�ba� <br />This applicationApplication is is i compliancewith Co (] <br />Installation will serve: Residence Apartment House F] Commercial F Trailer Court F1 Mofel 0 Other F1 <br />Number of living units: Number of bedrooms ]�) Number of baths Lot size ------ <br />Wafer Supply. Public system Community system E] Priva�e.kl <br />ft% <br />Character of soil to a depth of 3 feet: Sand El El Adbbe <br />Gravel E] Sandy Loam, E] Ciay Loam El Clay H a rdpan 0 <br />TYPE OF INSTALLATION AND SPECIFICATIONS - <br />(No septic tank or cesspool permitted if public sewer is �vailable within 200 feet.) <br />Septic Tank: Distance from nearest well -L --------------- Distance from foundation -------------------- <br />Material <br />-------- <br />p,ivv� Distance from nnuny� well D�+ � <br />' , __-____--__-----�� Distance +rom nearest 6ui|�;o� ---'----'---- <br />L1 Distance to nourom lot l�o`----_-.-��--..___--_ <br />Svo Rt DistanceP-Gion-~--' <br />Numberqf <br />- nearest� ~' �-~ <br />--- <br />-'D� <br />pifs../----Uning"*x,r |ume��r--_ <br />�---._Depth -°2T^�`-�-_�-_--''. <br />| Field: Distance 6nm'neares well D| n_ /01. ...... <br />.- <br />� )|m� " <br />� <br />Distance to nearest �* |�~�Num�, <br />i��� ��� |/ � <br />Type of filter material --Z.& -.Depth of filter material ------ <br />��0, <br />V�°. <br />Remp� |Tj t -- ------- ----------- ------- <br />~X�� )d -------- <br />------------------------------------------------------------------- <br />------------------------------------------------------------------------------------------------------------------------------------- <br />---------------------------------- <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countyordinances, State laws, and rules and' regulations of +he San Joaquin Local Health District. ------------------------ <br />(Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., musf.6e filed with this application). <br />�FORXEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY -BY_- <br />/- <br />'-'-'- <br />-*_--------------------------------------- <br />REVIEWED <br />----------'' <br />KENEwED B�7__'' '''DAT�_ ���+ <br />BUILDING PERMIT ISSUED. -'--''' -''--'----� <br />'' <br />Alterationswn6/nrrocommon6m+�nn;----_--___---__.___~______�-'-'-- DATE- '''-'--,-'----�---'�`-'-' <br />------------------ <br />------------------------- _�.___ <br />_-__--__-_-'_-'''''-_'''_-'''-�_-.''''--''''---�'---'''''--'''-_'-_-'-___''-___''------_.-`'-_'----. <br />._-____--__-._-__-_.__'-._-_-'_-__----�_--__._-_---_'__------_.--_---__- <br />' <br />-'�_'--''-__.'�'^'^_-''---.'-___'-.`'''--�.'~�---''-'_.,'.'-'.'_'-�--_-�-'''_'--_�'''��-'''----''%~''-~�--�'�-'_!_--" <br />- <br />.--'-''-'-_'--''-'''-'_--'''-''-'---_--'.. <br />---_-___---._- <br />PERMIT -------------- <br />(Date) FINAL INSPECTION BY: ---U)-----_'__--_-._---------------------- ----__. <br />ISSUED' -- <br />Date -'--''----- <br />SAN <br />JOAQU|N LOCAL HEALTH DISTRICT <br />130 South American Street <br />' Stockton, California <br />