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FOR OFFICE,U54i <br />� APPLICATION FOR SANITATION PERMIT Permit No. <br /> ' �'.-- .. - <br />� Application <br /> This applica+ion <br /> .made.in compliance with <br /> � <br /> , <br /> ~-- <br /> ' '~- ~` w�41 177 <br /> ' <br /> Ig <br /> Contractor's Nvmo'_ .-_'��_ <br /> Installation will mwnm; Residence .Apu,hnon+ Ho"im [] CommorcW '[] T,oi$� Court ` Motel [] Other <br /> � <br /> Number of |;vig'unitmN Number qJbedrooms 1... Numbeof baths Lot size ------------------- <br /> Wafer <br /> -_-.Wafer Supply: Pulafic system D Community system E]^ private V Depth to WAte, Table���_ <br /> - <br /> Char;cfer of soil fo.i depth of 3 feet: Sancl.X GravelO Sandy Loam Cl�L�m [] C|�[] �p�[] Hardpan E-) <br /> ) <br /> Previous 'Kxa6m: Ufyes,do�----_--.> No �� New Construction:- <br /> Ym� �� NOD FHA/VA. Yo� [] Nu [] <br /> ' T�EOF ]�TA' l �WAND SPECIFICATIONS": <br /> ^ '- ~� <br /> +* <br /> (N* sepfic.fank or cesspool permitted if public sewer is available Wifhin,200 feet.) _f) <br /> i <br /> Disposal FieldDistance from nearestwell '���� DIsfance from f0 6 6 . Di _Z�.' <br /> Type of filter.rn <br />| 0 x '='b= of r'^ ' <br /> Distance.t�-nearest- - lin--- <br /> ........................ -di 'J", <br /> I hereby certify �#ork will 69 done in actordancb with San Joaquin County <br /> o,rdinances, State laws, an 1.1.16" and'reg"I flon f the San Joaquin Locoliealth-Disfricf. <br /> (Signed)----------_----------------_ � <br /> By: <br /> -pla n-,.-showing.size - - ' .-- -e .............s-- <br /> FOR DEPARTMENT USE ONLY <br /> | ' �\PPLk��Tk]� ����EPT�D �i ��' <br /> .-.-�'�x�----__'-'_-.-------.'_--_-_--- narE 14��.__,_- <br /> REVIEWEDBY..................................-.......................___----------------------------------------------------------- DAT�'_-.�----.-' <br /> aU|��|N� PERMIT |3�V�m <br /> � �_._----------.-----'__----`--.----.- U*T�--_-.-._--_----_-_-._ <br /> ' <br /> Alterations and/or recommendations:------------------------------:_'-__---''.------_._-_-_----_-_.--.-^__'-____.___ <br /> { '--'------'--'--�----'--------'--'�-'.^`---'---^-'---''-----''-'-------------------'- <br /> --'--'---'----~---'-------r---'--------'---'---'---------------'---'----- <br /> \ ' ----'-------------�-----'--'----- <br /> � _''-' '-'---'-_--'--'-----_.'-__'-----_--- <br /> . ' <br /> FINAL N3 Do��--- ��~ <br /> � . - _ ...............-------................... <br /> SAN JOAQUUN LOCAL HEALTH DISTRICT <br /> ~ <br /> / <br /> 16011.w"xe*" Ave. 390 West Oak Strew 12*vp=rn°=woom 205West 9th w=. <br /> ` smw^*n cuowmia , Lodi,California m""te,a,o"xf*rnia Tro'cy,California <br /> r <br /> > . <br /> ( <br />