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� ~~ <br /> ~ ` ' ` <br /> m- APPLICATION ���� ����� PERMITPERMITPermitPermit No. .y�. <br /> SAN <br /> ' '^~w>�. ` <br /> � - (complete in Duplicate) <br /> _ W. 4121,t^a issued <br /> ! <br /> -��- <br /> ' <br /> m�� to the San Joaquin Lm�| HeuKhD���f� u p�m� tvum�mc erein described.«r� with County O� No <br /> / <br /> __dJOB ADDRESS AND 1 - -11 ,4. -- <br /> 4717 <br /> --------------------------------------------------------------------- <br /> Installation will serve: Residence R Apartment House E] Commercial 11 Trailer Gourt 1[] Motel L] Other Ej <br /> Water Supply: "Public -system P�"Communif� system _E] Private E] Depfh'fo Wa er Table <br /> Character of soil to a depth of 3 fee+: Sand L] Gravel Ej ' Sandy Loam E] Clay Learn E] Clay Adobe ET"THardpan El <br /> Previous Application Made: Yes Ej No'e, New Constrt�cf.ion: Yes. `f4o El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted publjc�sewer is available within 200 fee <br /> Septic T 'nk: Disfa' nce from neares'f w';11- Distanc� fromifoundaf�on--------------------Maferipl-'a -- - -------- <br /> a ­ '_ ... .. _­ /J.,�' - i------- <br /> Nd. of compartments-, <br /> near �j 12) line- <br /> Disposal Field: Distance from est w Distance from founclafion_____Z�-------Distance'to nearest lot ---------------- k <br /> Ty�e of filter n1aferial. --Depth of filfebriaferial -------Total <br /> Seepage Bit: Distance fo nearest ,41_27 ...Disfa�c2e from 'fou d Distance" fo nearest t ------- <br /> Number of pits---'Y--- ------ Lining maf-e-.rial-I <br /> ' `I ^ ' IN | <br /> � <br /> ' Privy;! D��ocefmvn,neona� wu|L'-_-',,--'-''�----,���Distance from nearest building'_-'---'-'-''-'-- (� <br /> � E] '' ` <br /> Distance <br /> �w� 1v�T\ire/ - ---------------^_` ..----'°---e�---'-_`^`-- ----------------------------------------'_--.^` <br /> ---. <br /> .------ <br /> _.--------___�- <br /> __-. <br /> Remoda|in� and/or repairing (6vd�b�:-�--!' -------------------------------------------------------------- _^�_^-____________ _-_ <br /> ' .� i , ~ ° , � <br /> __...__-_____'---._-_ --_..__~-_-'-_-----'__.-_.'-_-----.__.'''_-''--'-_''---_-.-''-' - -_- <br /> _�--______.____'__---___+ _.-____-__------.--------_-,._-- - -.-_``---=r----_---------_-_--_-.-----.-- <br /> -+^'--- -_. --.. --__-_.'''--',_-.-'-_-� '-----'-'-''-- <br /> � <br /> I hereby certify that I have p�- ~ <br /> \ <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> . ........ ------------- (0 e,�and/,�rC,,.t�racfrl <br /> 0y <br /> ir/ot plan, showing.size of /or /ncw"p" o, em in.relafion to wells, buildings, etc., can be placed on reveese side). <br /> � <br /> FOR DEPARTMENT USE ONLY <br /> . <br /> ---------- .------'_--.-----�_--------------__--_---_--_-_�._--'---`.`-._-__-.__'.--- <br /> ' � ' ' <br /> '----'--'-''___''-''---'----'-_''_'-'-'''--'--''--_--_--''-'''-- --------------------------------------------------------------------- <br /> ' � <br /> ---_-------�~-,�-----_-- . _^ - ---------------------------------------------- -------- _~-----------------------------------------'-_. <br /> � <br /> INSPECTION BY�.�-��-������..'��)�����//���_- ' �v��--'�- ------------------------------------------------ <br /> FINAL <br /> SAN JO/VQUDN LOCAL HEALTH DISTRICT <br /> / <br /> ,� s� �� �� � `� � S� /� ��� s� o/* N� � S� <br /> - � <br /> e=kt"". California Lodi, California Manteca, California Tracy, California <br />