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, FOR OFFICE USE- APPLICATION FOR SANITAT- I.: N 'PERMIT ------------------------------- Application is hereby made to tli�e San Joaquin Local Health District for a permit to construct and install the work herein desj:ribed. This application is m.6de in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATIQN ---/24T Owner's Name ------------------------- Installation will serve: Residence gj��partment House 10,Commercial F]Trailer Court :F.-I Character of soil to a depth of 3 feet: Sand'[] Silt 0 Clay El Pea t El Sandy Loom -E] Clay,Loam Hardpan.El Adobe E] Fill Material ------------ If yes, type ---------- ------------------ (Plot plan, showing size o� lot, location of system in relation-to� wells, buildings, etc. must be placed on iever (No septiic tank or seepage pit permitted if public sewer is available within 200 feetj 'D' Box ------ Type Filter Material --------------------Depth Filter Material Distance7t'o nearest: Well i No Distance to nearest: Well Septic Tank (Specify Requirements) -- ------ ------ ------------- Disposal F. ?1 'X(specify equir" ent ) _' - -iV- - - ------------------- - - (Draw ekisting-and required addition on reverse side) .1 hereb y certiN that I have prepared this application and ihat the work will be done: in accordance with Son Joaquin County Ordinances, State Laws, and' Rules-and Regulations-of the S" Joaquin Local' 'Health District. Home owner or licen- certi FOR. war. ^ A,,uC°//um *CCEp|um W-Y——' � ' D�TE � ��~_ ___8U/LDUVG PERMIT ISSUED _ _ � ____ -- ' ' ��----------------------- DATE .ADD|TlONAiCOMMENTS .__ _ — ____.___-_____ _ . __ _ _ -_ '- -- --'_'---�--'—_-- — _—_---_'--'--_.-----.—_'—.--_''—_ � � ' _ _ - '.--_------,-----.--'t �� . _ --'-�—_---.--_-- _ --.—_�_''-�—_—''_.--'— ''' _'—'---�_—.--_--------__---_- —'-----'------�-----'—'—''l — --'_---- Rno} |nspac�onby ---'---._—_-------------Do+e SAN ]OAQU|N LOCAL HEALTH DISTRICT / �� - ' �jH.� l''68 Rev. SM � .