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\ <br /> \ ' APPLICATION FOR SANITATION PERMIT Permit No. - � \ <br /> (Complete - Duplicate)` Dufe Issued -ZA11-05- <br /> Applica4ion <br /> made to the San Joaquin Local ealfh District for a perm;f to construct andinstall the work herein clesc6be'd, <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND <br /> - ". - -----~_`-__--_.--'--'-- -------------------------------------- Phone <br /> --''-'----'_-' <br /> A66n,ss__. <br /> Installation will serve: Residence 2-�_Apartmenf House 0 Commercial F] Trailer Court E] Motel Other E] <br /> Number of living units: --- Number of bedrooms -3--- Number of baths -A--- Lot size .---Ze... <br /> 47--------------------------------- <br /> Water Supply. Public system Community system E] Private Z-_"Depfh to Wafer'Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [:] Sandy Loam Lj��Iay Loam 0 Clay [] Adobe E] Hardpan E] <br /> Previous Application Made: Yes 0 No 9?'77qew, Construction: Yes 91'�`No EI <br /> ' TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> V ` <br /> v <br /> (No septic tank o, cesspool permitted if public sewer laavailable within 200 feet.) ~°=~ <br /> ' <br /> Septic Tank: Distance from nearest we| /~ ---Distance from fourl �on. ---Maiprial------ .� <br /> " �� No. ofoompa�men!�--.- S�e �����,v�.��_'�qui6 6ep±h-'4�',- ---C*pmcDy-`_ <br /> � Field: Distance from nearest well--- r Distance from foundationo" Distance to nearest lot |ine__:�57^ <br /> N m6eci� line, <br /> Seepage Pit: Distance to nomnwt w°�J---_---Distanco from foundation--- ---------------Distance to neoresHof1 -�O-- <br /> --------------- <br /> [] Numberofpit»''-''-''—Uning material -'--�'---�Size: Diameter ---------------------Depth------ ------------------------- <br /> Cesspool: Distance 'from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> [] -Size. Momefoc--.,------- --------Depth-------------- ----------------------------------- Capacity--------------------- `|o.' <br /> .01 <br /> Phvy: Distance from nearest well � ---------------------------------------------Distance from nearest building-------------------------------- �~ <br /> Distance to nrupeof1o+ line------ --- ------------___—.----_--_`---_--_____�_____ ~ ` <br /> Remudo|ng and/or repairing (clesc,ibe\:------- ------------------------------'------------------------------------_---------------- __________._____________ <br /> '-''--''--'-'''--'--'''--''''-''--''---'''-'''----''--'-'''-''-'''---'----'--'------'-'---''-' ' <br /> . <br /> --''--_-'''''---'-''-_--'''-'---------'-_.._-''---_---._-'__-___-''-'''_____----------- <br /> ---------------------- ------- ------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San <br /> ordinir ances, �w� JoaquinCounty,. <br /> (Si <br /> r,r'~~�' *^- ^~���"`"� ----------'-..-----'--'-(Owner and/or Contractor) ' <br /> . � ---------------------------------------------------`--, '''-'''-'-_.---'-'--'---'� <br /> ` <br /> (Plot plan. size oflot, ��o of system in ��� �*�� . etc., �n 6� :��� �n ��e ��wl <br /> . . <br /> APPLICATION ACCEPTED BY--- <br /> ^ ~ �'�' -~_--� <br />