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FOR OFFICE USE: - . <br /> / ��c� pmn�+ �� <br /> ----------------------------------------------- �����K���h�APPLICATION �KFORSAJNY|��Y���v �^nn <br /> / <br /> icatel <br /> This Pir-mit Exoires I Year From Date Issued <br /> Application is hereby made to the San Joaquiri.Local Heal+h District for a permit to construct and install the wor <br /> This application is made in compliance wit�fLounty Ordinance No. 549. <br /> JOB ADDRESS AN�D --—---- -- - ---- ------------------------------------ <br /> Installation will serve: Residenc Apartmen Ouse �;Om.mercial E] "Trailer Court 0 motel 0 Other <br /> Number of living units: ___/--- I <br /> Water Supply: Public system M Community system 0 Private [j 1)epth TO Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand [] --pravel 0 07-:0 <br /> Previous Application Made: (If yes,clote--------------------I : No F1 New C.onstruction: Yes t5 No [] FHA/VA, Yes [] NOJR--,�, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank. Distance from ---��r...Distance�,from -.&'-e--- <br /> 11------<_j2_,_Distance from foun( Z.V. &_.Distance to nearest lot line----- <br /> Distance from nearest we K - <br /> ta 0 W Jation_V <br /> Type of filter material--------- ------6epth of filter rn.aterial_�----- <br /> Distance fro f d tion.... ......Distance to nearest lot Iine__­��- <br /> Number of pits Depth <br /> __-----�___--'----- <br /> \ -------------------- <br /> Remodeling and/or repairing (describe)�._-_-_---.---__---.._-._.__..__.________._._____� <br /> � __-___-_--_--___-'_--._-_-'-__.---_.__.-'___.__.-_-'_-.--_ .—_--_..__._—_--�---_-' <br /> -'----------'------'---'----------'7�-----''--'-'--���� -- � ___'__------------ <br /> � ----------'-----''`---'--''--'--'----�� '� accordance w�6 San Joaquin County <br /> --`. <br /> I hereby certify that I have prepared this application <br /> ` ---'---'--'--''------- ��6 t6m� +h� �mr �� 6edmnmm <br /> rul <br /> Local Health District. <br /> w -- n �-�"�r6\ S* _ � ,~=g~J°r= `_n <br /> v° � __ --__- <br /> _-- <br /> - <br /> � <br /> -_---.------_-----. mn-6 <br /> / <br /> m, Cmn�m*+wr <br /> ''-'--'--' <br /> ~'---'------------------'-- � --'---- <br /> (Plot mlan showing size mflot, locwfion`mfsystem Yn relation *uwells, bu3Jingo etc.. can be placed on reverse side). <br /> FOR DEPARTM USE ONLY <br /> | ---- <br /> PERMITpe- <br /> BUILDING <br /> ISSUED-------------------------------------------------------- <br /> Alterations <br /> >7------------------- --- ------ ------- ------------ ----------------------------I...... <br /> All <br /> Do+o ''—'---------------'---'' <br /> / <br /> FINAL INSPECTION 8Y:-'--�--__'-''__—__--'_- -- <br /> � ��N |NLOCAL HEA�H �5T�CT . ^ <br /> � Sycamore Street xm�w*m�+o�°� <br /> v����+��� a�w����� 12*�� <br /> . s��mn California Lodi,California Manteca,California Tracy,California <br /> cnpREVISED 8-59 2M u'au xrL^o <br />