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- ` <br /> � ' \ <br /> (Complete in Duplicate) <br /> Applica4,ion is'hereby 6dd to the San Joaquin Local He'alfh District for a permit to construct and install the work herein described. <br /> T)his application is made in compliance �iith County Ordinance No. 5 <br /> Cvnmcfo�sNomo___ APPLICATION FOR SANITATION PERMIT Perm;4,No,� <br /> --^---------------------------------- -- ---------- ------------------------------- Phone........._._.-__---_ <br /> Installation will serve- <br /> ' '^_id�_' �~ -!Apartment Hous <br /> _ ntHouso �/ Commercial ] Trailer Court [-] Motel - r [] <br /> arof bedrooms Number of 6u+h '� o+ �zo __ � <br /> .--.Num6erof \��ng units". _;��munity <br /> %*~' . ' b ' <br /> � . <br />' Water Supply. 'Public system system [] Private [1 Depth to VVa+o, Table --'.-ft- ^ <br /> Charac'to, *fsoil to depth.of 3 . *Sand [] Eruvo| E] Sandy Loam [] Clay Loam [] Clay [3 Adobe [] <br /> Previous Application Made: �Yes-E] NoU4---NowCunshucMon: Yo,dg_~NV[] <br /> ^ . . . ` <br />' <br /> TYPE �ND �P8�|PK�ATDN� - <br />� (No septic tank or cesspool permitted if public sewer is ave <br /> ' ila6le 200 feet.) - <br /> � 1 <br /> Disposal Field: Disfance-from nearest w6ll..A_/ -1--t-bisfanc"e.from foundation------- -- -----Pisfance to'nearest lot line_____5'__ <br /> Nu'mber'of,line's-------------)t------ -------------�Lengfh of each lineAO'�/ '1,S..Widfh of trench------;---- ---(---- --------------- <br /> -filter material Depth'of filter material_ -----Total length-------- ------------------ <br /> Type ofis� <br /> Seepage <br /> ,I� m"o �Number.�� pits + v_.-S��� D�mo�,,..� 3.L~--��Depth �� �, ` L�ing <br /> , <br />| Cesspool: Dixh,6te 6nm'neoco� wvL��'�''.�D�funo: from {oun6ut��—'_�-'-Um�g mute�uL�-'�-'''-'-_-.-_ <br /> 6' ^ ��me+v / �opf ^ , '�6 Capacity gals <br />. �� /oe� c'_'''-'''- uopm'',�''''-_.'�'-''''—`—��� ---'---''�-gu . <br /> ' ! ------------' ^ . <br /> Privy:' Dist noy",nomnearest well '_-��''�''-_'''-'''-''Distance from nearest building------------------------------------- -Remodeling and/or ' <br /> ' <br /> 11j'hereby.certify th �$1ave pr I application and fh�t will-be 4one in accordance with San Joaquin County <br /> ? the Work <br /> ordinance:s, State laws dd rules jand 7rielations of the San Joa in Local ZHeal District. <br /> (Plot plan. showing size'of lot, location of system in relation i(i 'Wells, buildings, etc., can bi'placed,on teverse side). <br /> FOR DEPARTMENT USE ONLY <br /> � <br /> APPLICATION ACCEPTED BY--------------------------- '�...&----- DATE_'-.���--/_.L --------------------- ' <br /> REVIEWED B\�'�----''�-''�-'-''-�---_--''�-.-`''''-''-.'-_--''--.'' D/�E-_,''-'-__'-'_'__.-__'-' <br /> BUILDING-PERMIT ISSUED_-_-'-�_._-'--_---._-_-_------__. DATE�.--_._-�_---.---..__-. | <br /> ~ /n6at�nu�-,_------.----_.-- � <br /> ��ara+�n� mn�/�rruco��� .------------------------------------ ---___-�---- --------------------------------- <br /> ''__.''�L--��''-''_-''_--'---'- -.''''-''--'��--''''-'''�---''''--''---''----'-----''-''- <br /> . � . <br /> -''-''-----'''-''r'---'''­­''-''—'-''--�-'-'---------''--''''--------------------------------- '___----------------------------------------- l <br /> ----------- --------''_--''--'���'--'''-'-'-'''--''_-'�_''_-''-_'�'--''-'''''__''--_-'---'-'--'---''-''-'' � <br /> ! ' � ----------------------------------------------------- --------------.- <br /> -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> � /30 south Arnarican Street, 300 West Oak Street /32 Sycamore Street 814 North "C" Street <br /> ' California Lodi, California Manteca, California Tmov California <br />