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APPLiCAtION FOR SANITATION JPERMIT Permit No. <br /> (Complete in Duplicate) W­/a 2- � <br /> .3477 db/O(Z-Date Issued <br /> 393 <br /> 'A�plica4,ion is hereby made to the San Joaquin Local Health District for a permit to constru a 11 11 h e_4177e—re escribed. <br /> T is withn C-sunty Ordinance No. 549 <br /> application is made in compliance ;Z60 <br /> ------------------- <br /> Installation will serve. Residence [:] Apartment House E] Commercial [] Trailer Court 4--motel 0 Other 0 <br /> Water Supply: Public"system' E] Commu nity system El Private 14-ft-plh to Wafer Table�_"_ 'ft. <br /> Character of soil to a'depth of 3 feet: Sand El Gravel El Sandy Loam El Clay Loam [] Clay [-] Adobe pan 0 <br /> Previous Application M'ade:. Yes E] No ±r—New Construction: Yes 0 No [A-- - <br /> TYPE OF /NSTALLAT|ONAND SPECIFICATIONS- ' <br /> /Nwseptic tank nrcesspool permitted ifpu6|iusmwmr � avai|a6|mw�6|n3U0femfJ <br /> Septic Tank: , Distance from nearest we|L-----Distance from <br /> �oundution-_--:--Mute,iaL_--------__.-_.__ <br /> No. of compartments- .Size-.. . . ... Uqui6 dvpfh- -_-.Capacity_ .. <br /> Dispnsa|'n=ld: <br /> ' <br /> � <br /> Didnnp: f�v� no�r�� wo�-''''--.D�f Distance from foun�ut�n '-',-'--Did�no� to nearest |ot |�o-_-'-_ <br /> ber <br /> .Oo <br /> El�]J�~^~~-' - - <br /> / nr `/ry ' r / « urn <br /> SeepageP� Distance to nearest U-.20jpDistance t� nearestlineof--- <br /> D�of4& ^ 4 -- <br /> Number 6 <br /> -------------- <br /> ` -__-_..g and/or repairing- .�___-,--------- ------------------------------------------------------------------- --------------- ------------------------------------------------------- \. . <br /> ------'`------------------------------------``---`--------`-------`------'`-------------------------'--------``---------------'------'---------------------`-----``-----------------------`------'--------------' <br /> ----------'--r-'----------------'------'------'------'----------------------------------------------------------- <br /> -'' � <br /> ----------------------------------------------------------------------------------------------------_------------------------------------------------------------------------- --------------------------------------- <br /> ' I hereby cerfify-fhaf I have prepared this application and that the work will be done in accordance with San.Joaquin County <br /> ordinances, <br /> + <br /> _ Bv�- x���- ------ ----------------------------------------- __.��__.___ ° <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE ==�c� <br /> ------------------' --------- --' --'---f�'-== '' --------------- <br /> REVIEWED DY--_'�_..__._----- ------------------------------- DATE 0ATE._--���.-''�}L_��_.----- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-'-''_--_''-_--'''-_-_____ " <br /> AKn,utiono and/or recommendations:---------------------------------------------------------------------------_-----_.---------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------' <br /> ' <br /> -----------------------------------------------------''-''--'-'''—''''''-''--''--''---'---''--'--'--''-''-''-'--''''---'-----'' <br /> � <br /> ------------------------------------------------------------------------------------------------------------ -----------------------��__��_-------_----__---_------'_---_-------_____---_-----_--------' <br /> ----------------'--'--------------'-----------------------------'---- <br /> FINAL INSPECTION' <br /> ' <br /> �- <br /> BY�----------�L[.�]����]�?-- ' Duta-----.------- ------------------------------------ ......... <br /> � <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> /vo South American �� <br /> ��", w" °^ »uow*� O" Street oSycamore Street z �*�v ^» oNorth ^u^ Street� sm*kt*n. California Lodi, California Manteca, California Tracy, California <br /> � <br /> ES-9-2M Revised W-2100 <br />