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� <br /> APPLICATION FOR SANITATION PERM[[ <br /> (Complete in Oup[icate) « <br /> Application is hereby made to the Sun Joaquin Local Health District for o permit to construct and install the work herein described. <br /> This application i dl |i with County Ordinance N <br /> """ ADDRESS AW LOCATION J '--~��� �---'-----------------.- <br /> --'- <br /> Om � � �� - ' <br /> ---------.-�------------- P6one---.---_------- <br /> ---'------------'-'---'--------------' <br /> ^ � <br /> Contractor's Name.--,�m��.�^���'-' �~�w-.---_--'_---------------' Phone--- '---'^���l�' -- <br /> |n�uUmf�n will aurvm� Residence /\par+m�nt House [� Commercial �� Trailer Court [] Motel E] <�+hnr E] <br /> ,. ~ <br /> Number of living units: v- Number of bedrooms A Number of 6u'fhn [A Lot dza'4-17-'09( ^~ - � <br /> ��� <br /> -' ' <br /> Wmter %upply: Public system [j Communify~sie,mb Private � <br /> Character of soil to depth of 3 feet: Sand E] Gravel E] Sandy Loam 0 Clay Loam E] Clay Adobe ' '4 Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> E- No. of compartments ---- Capacity-----------------------_-_ Liquid depth. <br />, -------------------------- <br /> Cesspool: Distance from nearest well Distance from foundation Lin L_ <br /> E] Size: <br />- Privy: Distance <br /> [] Distance <br /> Seeo -Pit: Distance to nearest well-------8-�O-.......Distance <br /> foundation_../ �'^--Distance <br /> -°�f-o <br /> nearest <br /> Number '�� ------' = ' '' ~ -'~ ^'~~~' ~'~^ ==---' Depth----- <br /> �� � <br /> ------------------- <br /> ,Disposal Rn|6: Uis+unoa from nearest well--- from foundation------ -----Distanca to neatest lot line-. �0 -w <br /> [� Number of lines---------/-- Length of each line-_ 3-0 1� of trench ---------------- <br /> Type <br /> '__ � <br /> � Tvoe of filter mate 6aLJ-C.--W'Depth of filter mutoriuL. <br /> Remodaing and/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 laws, and rules and' regulations of the San Joaquin Local Health District. <br /> pw _____.______ ^ <br /> 12 <br /> -"--' --------'-'-'-----'{' ------------------------ <br /> (Plot <br /> ------VPlot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this a <br /> FOR -_. '-._.. USE ONLY <br /> APPLICATION ACCEPTED BY--------- DATE---- <br /> -- ------------�­------------------------------------------------------------ 7----------------- <br /> ` <br /> -_--'__-___'-_ ^�� <br /> If <br /> --------'�-_~--.._ ^�' ~~_'~~�~.�_ ---�__._-__.____.-..___-__�._ <br /> ----or ------------------------- -----------,_------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------ � -_-_''-__-''-__''''--''- � <br /> 9ER>�|T Nox�� - |SSUEO-_ -�/ 'Dm�� RN/\L INSPECTION BY:-------------- <br /> Date--------------------- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT ''* <br /> \ <br /> 130 South American Sfreet � <br /> /~ <br /> Stockton' California ' <br /> ES-9-2w9a0W^1639 <br />