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~r _ <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires I Year From Date, Issued <br />FOR OFFICE USE: <br />Dote |xsuw�� <br />- 7 � <br />Application is hereby* made tothe San Joaquin Local Health District for npermit +oconstruct and in�nUthe work he, indesci6w6 <br />This application � <br />�oon �de in compliance with y Ordinance o� h �qon�On�|N549 and existing RulesRegulations-. u|o�nn� - - �. ' <br />' - <br />Juu*uuu*u, �u�a/x�v `- <br />' .R"C.------.---+- <br />wv,no,v Name...vnr._�, <br />._,._~^_4 , ~, `+ ^~ ^� _________ ___� �y ---Zip����s�-:g���.- � <br />C,n�oc��o Nomw_--� `-----------.----_—License #----------------------------- Phone---------- -_--'—_ <br />' \nstalloipnxvU|-,o,ve,~--^` ,Residence Co. Apo,tment,Hovso[]_ Commercial [] Trailer Court[] ` <br />-Motel [:] Other --_-`-�-­-.'--'���-- <br />� � <br />Numbw,of|iv�g onirm_�--�]Nun?6e offe6n,om,� ���' �hn6o�-----�� Size-_.., <br />` ' .- --.--_-'_----'_-'' <br />Water Supply, Public 5v,�m and name.. _.._.__^_`_____`__~___._____._-.-___._------_-Privote�� ^r <br />Character nfsoil. ^o o depth of feet �Sand Silt [] {Jay E] Pto+ [] Son dy Loam Clay Loam [] <br />HunJpnn[j� Adobe'[] FN6�c�edo/ If yes, typo -- ^ <br />(Plot plan, showing size of lot, location of system in relation to'wells, bbildings, etc. must be placed on reverse side.) <br />perktted if public sewer is available within 200 feetJ J <br />NEW INSTALLATION- (N8 septic tank 6r seepage pit <br />D i stance; to. r�eci rest: <br />` ' � <br />---� ------- �um/ �nc&n,nearest: <br />Well ... <br />n|...-��c-'----.--_Fovn6c*-io- n---�''-------Property —Line <br />-...... <br />—___ <br />------------ <br />SEEPAGE <br />-._SEEPAGE PIT Depth- �-DiomonscL--'----]Nmm6pc-�—._-- - Rock Filled Yes E] No � <br />� <br />Water Table De.pt�.-�.-___-1: ------ --------------------------- Rock Size --.—' <br />Dimoncex,nem,ost. Well-.*..,-.-* ... .......... .............. :------- Foundation'---- ----------- Prop. <br />' <br />Line -----,-��� <br />REPAIR/ADb>TION(P,uvSo'�otionPonn���--''-�.--+-_�.--�---�Dp�--�'---_---------') <br />' ' ^ <br />SepticTok(Specify Req <br />