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«� <br /> APPLICATION FOR SANITATION PERMIT "' V "� � <br /> �� w <br /> (Complete in Duplicate) t <br /> Aou||cuKun is hena6v made to the San Joaquin Local Hn°|H` District for o permit to construct and install the work herein described. <br /> This application is mode in compliance with County Ordinance No. 349 <br /> Me <br /> Address <br /> Installation will serve: Residence E] Apartment House E] Commercial E] Trailer Court 0 Motel 11 Other El <br /> Number of living units: M Number of bedrooms E] Number of baths E] Lot size----10-e—A,Z-A-a---------------------- <br /> Wafe, Supply: Public system E] Community system E] Private [:] <br /> Character mfsoil +ou6mp+hmf3feet: Sand [3 Gra"e| E] Sandy Loam E] Clay Loam [] Clay El Adobo [] Hm,6pnn' ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: « <br /> (No septic tank prcesspool permitted R public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well Distance from foundationMaterial <br /> Cv,spoo|: <br /> Privy: Distance f <br /> ------------------------------------------------ <br /> Seepage PM: Distance to nearest well---- ------Distanceem"fou Ofi6n_ __A0__ <br /> ------ <br /> Numberof ' <br /> ~-� . � ~ ������� . <br /> ------------------ <br /> Disposal Field: Distance from D�+ -----'foun6a� ^ /nce to nearest lot <br /> --�� | <br /> i ------ <br /> Number <br /> - <br /> Num6�r �� lines _- .. 'Lonof' c� muc� line -������ .� ��tk of ------------------------ <br /> Type <br /> --_--.__Tvoo <br /> ' <br /> of filter material-------------------------Depth of filter m*+ariaL''--___.' <br /> Remo6slingand/or repairing (describe):------------------------------------------------------ ------------------------------------------------------------------------------------------ <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 County <br /> ordinances, State IWvs, rules d re lations of the San Joaquin Local Health District. <br /> 1rT 0— -P --- ----- -------------------------------(Owner and/or Contractor) <br /> �"y"ep/----0c <br /> (Plot plans, showing size of lot, location of.system in relation to wells, buildings, efc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> ` <br /> APPLICATION ACDATE--- --_'---_ <br /> -� ___ <br /> ^ <br /> REVIEWED <br /> ---------- <br /> BUILDING PERMIT ISSUED-_- ----------- <br /> - ---------------------------------------- DATE----/-----°~'-- _''�� � <br /> � --'------ <br /> A�o�t|onwand/or rocommon6o�nns:----.------------.-----_--.-----__._.________________..r-+--------,Z------------- <br /> --------------------------------------------------------- ------- ----------------------- ------------------------ --- ------------------------------------------------------------------------------------------------------- <br /> ''__—_.—_—__.__.''''___'—__''-'___''—__.'-''__'-_'--_.''---__----___.--___.--__—___-----._. <br /> -------'------'---------------'----------'--------------''------'---'����---_----------_����������������������-------------------------------'-----'�----''------'---------- <br /> ''—'—_'__''-----''''--'''_-_ --.-''—___--______-----.___—__--___—_ <br /> PERMIT' m- ~/AX7 — |SSUE _- Du+e) HN/\L INSPECTION BY:-------- <br /> -' ------------------------ <br /> Date--------------------------- <br /> SA <br /> }� �t���'U|N U]��,�[ H��LTH DISTRICT <br /> y <br /> 130 South American Street <br /> Stockton. California <br /> sS--9-2w v'so vv'|asp <br />