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APPLICATION FOR SANITATION PERMIT Permit No. <br /> ��mo�n � Umn�m� � <br /> ^ '—' '---' Duh, Issued <br /> Application is <br /> . <br /> a�6v mu6o to the San Joaquin Local H H� D��d for u permit to constructd install the work herein 6escribo6 <br /> This applicationi J in compliance with County Ordinance N <br /> ^°" "°�~�" "'`° "~`~"'=`— —' a~�o�����-----------'-----------'' <br /> C)wnnr'oName.---------...���-�.---..=��/ ----.�-------_-----.. Phonn---_---._--' <br /> ' <br /> Address....../---------------------------------------------�. -- _------____''--_—.—.—__-_--_—'—_---_—_' <br /> Confr*c+oFo Nome.__�----__----._]6� ----.----_—._---_----_---- Phonv`._--'_.----. <br /> Installation will serve: Residence P� Apartment House E] Commercial Ej � <br /> / »' � <br /> / Number of |i�ng units: --- Number of 6o6,00mo .,�—. Numberof �m -u— Lot size --J%xvL ----.—..�— <br /> Water Supply: Public system Community system El Private eDepth to VVotor Table -------- ft / <br /> Character of soil to a depth of 3 feet: Sand [] Gravel L] Sandy Loam El Clay Loam E-] Clay 0 Adobetr—Hardpan <br /> Previous Application Made: Yes No J:;��e Construction: Yes(L;��o I] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public?ewer is available within 200 fee!j_ <br /> Ha <br /> Se f'c Tank: Distance from neareST well <br /> c r I <br /> nelrest lot 't <br /> Disposal Field: from nearest weK_4M__ _ D�stance from f oundation- sfan o to nearest lot linet-,------- ----- <br /> N6m ber ol iines----------I------- t t------------------ <br /> est-lot 6e` � <br />� Remodoing and/or repairing (describe):------------------ ------------------ ---------------------------------------------------------- ------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ^ <br /> ---'----'---'—'---.�-_---'—_'--__.—__.''---''___—_-'__—'—__-'—_-'�'�—'—'�—__.'—'-----'—'_ <br /> _________________________________'______'_________'__________'_____�_________________________ <br /> | hereby � <br /> ordinances, State laws, and rules and regulations ot the San Joaquin Local Health District. <br /> (SignoJa ._----_--_------------(Ownm, and/or ` <br /> ------------------------------------L--__-----_----.__—_----.(Tif le)-._----'—_—_.-------- ' <br /> (Plot plan. showing size of lot, location of system in relation to wells, 6uVdings, etc., can be placed on reverse side). <br />' FOR �� � <br />� ~. <br /> ----------------------------- <br /> REV|EWB} BY------------------------------------------------------------------------------------------------------------------------- ------------------- ----------------'---.'.. <br /> BU|LD|NGPERW|T |SSU2D—___''--'-_—.''—''--'''—''—'--''---'--'''—'— DATE'—'--- ----------------------------------- -------- | <br /> Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> '-------------------------- ------------------- --------------------------------- ------------------------------.............— ------------------------------------------- '' --------------------------------------- / <br /> --------------------------- __ ------------------------------ ----- --------------------------------------------------------------------------------------------------------------------- ---- ---------------------------- ` <br /> '--'--''--''--''---'---'''—''--''--'--''''—''''—'---''''—''''—'''--''—''''---^'—''—'—'—'''�'' <br /> -'' ------------ '—''--'''--''''—'' —''''''—''_-''--''—''''—'',—'---''''''—'—_''—'—'—_' . <br /> '.* . <br /> - <br /> �N�L INSPECTION 8Y�—''''—' '���'—''-- Do+o'�'�—'—'z�` '—''—'''--- <br /> V - ' <br /> � <br /> ' <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> /so South American Street wmvest Oak Street /32 Sycamore Streeow w"*h "C' Street <br /> S+v k+"". California LoJ|, California Mvnte"", California n*c» California <br /> ES-9-2M m-oz n.~/"°a vv:�2190 _�� <br />