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APPLICATION FOR SANITATibN PERMIT <br /> (Complete in Duplicatei *3/S <br /> —`` hereby made to tke San <br /> with County <br /> ~ <br /> Installation will serve: Residence Apartment House Commercial 0 Trailer Court 0 Motel El Other E] <br /> Number of living units: I I <br /> Wafer Supply: public" system [E Community system El Pr�vate <br /> Character of soil to a depth of 3 fee+: Sand E] Gravel F Sandy Loam .El Clay Loam El Clay El Adobe a4ardpan El <br /> TypG OF INSTALLATION AND SPECIFICATIONS: <br /> (Nm mopfl* tank or cesspool permitted ifpu6|Y*sewer � a°o||a@K <br /> available within 200fnef� .v <br /> ` ' <br /> Septic Tank: Distance from nearest well ' Distoncu from foundation -Mafo,ioL-----_----_—_----- <br /> . Se Liquid u <br /> _� \u� <br /> ° <br /> Ce Distance from nearpst wel. 69-0-1 Distance f f ';'clation-M ai.... <br /> Seepage Pit: Distance to nearest well----------------------Distance from fou.,ndation------------:-------Distance to nearest lot line <br /> Oispo:u\ Field: Distance from ne�rodi well------------------Distance from +uuh: dutmn--------------------Distance to ",a."". .". ,. <br /> .-'---.--- <br /> 7� Number nflines-----------------------------------Length of each |iq:e-.. .. Width of trench----------------------------------- <br /> Tvoo nffilter material --'__—'------Depth offilter material_----''�-- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />� nr6� State ,~ ~~, Joaquin ____lHealth_ . <br /> ---------------------------------------------------Owne, anw/or Cpn�a=,"v <br /> | ��»a�L- ' ----'----� � <br /> —__-'--__.'-__'''''—_—.----__—.—_----,"=+''—_.'—''''—_.'__—__'----' <br /> "r-----m �� ���� ��� ,� 6�m� ^� m� � �� �� � w��' <br /> N»�f ��n� �ho~�gs6� . ��o�mn . <br /> FOR DEPARTMENT USE: ONLY <br /> � <br /> / _---------- ----.--------.---' <br /> APPLICATION /4 ED BY —_---.,---.--__- DATE <br /> .—_.__—_''___'__.''--''__—'— . <br /> ------' <br /> PERMIT Nu. |5SUED--'^_- C�t�� ��[���(Dnfo) FINAL' ON <br /> / ^ ' <br /> Date�-�'!_—.�--..---_------_—_______.__ <br /> ! <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> - _ ._ South_ American � <br /> Stockton, Cakfn�nia <br /> � - <br /> FS_9-2w 9-SoW4639 <br />