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/ <br /> | APPLICATION FOR SANITATION PERMIT Permit <br /> ` (Complete- � Duplicate)' <br /> ''/ Date Issued <br /> ' ' --' - '---/ mu6a fu the San Joaquin Local Health District for o permit to construct and ��aUthewor" 6nr�in described. <br /> This <br /> r�.�o�d <br /> 'TZi <br /> \ <br /> nty <br /> \ <br /> � 6v in compliance w�� Cou <br /> JOB ADDRESS <br /> , <br /> � <br /> ',^" \ <br /> Installation will serve: Residence , Apartment House El Commercial [] Trailer Court El Motel U Other <br /> Number of living units: -- ----- Number of bedrooms ---f- Number of baths --]--- Lot size ---- 9_,q----------- <br /> vvofar Supply- rvuxc system M Cnmmun/ty system 1J Private LJ Depth to vVutv, |oh|e -------- tt � <br /> , <br /> Character of avU to o depth of feet. Sa 6 ravel Sandy Lo Clay Loom E] Clay E] /\Jo6enzr~ H�,dpon E] <br /> Previous Application Made: Yes E] No �� N�w Construction: You ; No F] <br /> TYPE C}FINSTALLATION AND SPECIFICATIONS: <br /> , (No septic <br /> Septic n k: Distance Di +a from nearestwell- <br /> ------ <br /> ---------- <br /> No. omu � <br /> � <br /> Dioe <br /> je|d: Diofonco from .. �) <br /> Number of ||n of each line----------- _ <br /> Type of-filter mote of filter mo+n�oL-''/- ------]ot | length-_ .-.--___.- <br /> 3eepag Pit' Distance to nearest well Distance from foundation Distance to nearest lot |i <br /> El Distance to nearest lot line -------------- <br /> R;Roy ---------------------------------_--- Z <br /> i ;R '----'-' ~ <br /> -_ .___.-- . <br /> '____-_______..-----_-'--�_�-__--______�--�___--._--_'-___-____-__--_-___-_--_- <br /> . .^ <br /> ' ------------------------------------- <br /> ------------------ '--______-'.._____-_.___.-____'.-_--._~-____._'-'---_-___-.. <br /> | hereby certify that I have p4pared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,' ~'~'~ laws, and rules and regulations of the ~~' ~~~y°n ^°^a' Health District. <br /> � <br /> ' By: ---------------------------------_------------------------------- ."le)-------------------------------------------------------' <br /> | K`lot plan, showing size of lot location of system in relation to wells, buU6ingo, mh:, can 6e placed on w,°eme oi6*L <br /> . <br /> FOR DEPARTMENT USE ONLY <br /> '----'-------'''''--''''---''---''----''-''''-''----'''-'--''---''----''--''--'----'--'--'---- <br /> ___�_____'_______________________________________'___________________________'_______'_________ <br /> .-_-_---_-------_.___-._------------__-------._----_-_-----._--_-__. <br /> RNAL INSPECTION BY:--��1/1,11V--------------------------------- Dut,-- -��--_---_.__-__-_. <br /> / x � <br /> ' SAN JOAQU|N LOCAL HEALTH DISTRICT � <br /> /m south America" Sfreef 300 West Oak Street ox Sycamore street ow worth "C' Sfreef <br /> Stockton, California Lodi, California wv"m*^ California Tracy, California | <br /> � <br /> ES-9-2M 8-5/ xovaod vv-2/00 �� <br />