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FOR OFFICE USE <br /> '��z�� �� <br />� (Z ~~°�APPL��ATl���� FOR S�^����kTI����`PE����IT - Permit� No. \ . <br /> ----- ^r (Complete in <br /> _ --,'--' ��to |vx��� -.��. <br /> - <br />! This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the S*n Joaquin Local Heal+h District.for a permit to construct and install the work herein described. <br /> This application is made in compliance with C6unty/9rc1,nay9 No. 549. <br /> Installation will serve* Residence Apartment House Commercial 0 Trailer Court [] Motel [3 Other 0 <br /> Number of living units: -Z!. Number of bedrooms �-- Number of baths _'� .^. ^.. _----'-'----_-'---'.__.-- <br /> �m�` � <br /> �� .^. mm� ��m � mwn� ��m � ��� � Doc� � ��r �L� -_ � � <br />� <br /> Character wfsoil bma depth wf3/fee+: Sand E] Gravel F] Sandy Loam [] -Clay Loam [] Clay [I Adobe[M Hardpan [] ` <br /> / - <br /> Previous Application Mmdm: (Ifyes'6ate-------------nn==)—No—El— New Construction: Yes C8 No [] FHA/VA. Yes [] No ' <br /> TYPE Of INSTALLATION AND SPECIFICATIONS: - <br /> (No septic tank or cesspool permitted R public sewer is-available � ��m 200 feet.) <br /> � <br /> - � /~ <br /> Seot� Tm k t <br />� p~ — - —',----nts ~ ~'^~ <br />� �. Capaci <br /> CXqzosm| F�|6: D�+unce <br />| <br /> isf6ince from foundation........ ---- Distance to nearest lot line..... <br /> Number of ��� �� �.D� �� � G�� m�e�| � �i�tl <br /> length � <br /> � <br /> --------- <br />� 5ompugn Pit: Distonuu+o,nn*rost;ws Distancetn nom�ef �t /�m.'-_''' <br /> � Number � �� �n|� ���| S�o� Diameter D�� <br />� -._--- '-_''-''-' -_-'-'''-' ' --''---_.---- � <br />� : Distance from n*unu� wmK'_----D��nco �nmfoun6u+�n�-'''-'--L�iog motm,uL''''---'____-', ` <br /> [] Size:.D�mefer_----'------------------------Depth----------------------------------------------------Liquid Capacity-'_--'---_gm|s. <br />� <br /> Privy: Distance from nnan»m well '_--''-_.'--'-'---'--Distance from nearest building'--'---------.--- Y` <br /> [] D|stanceh, nnu,ost lot |ina----_--'_--_—._ __.-''-/--.___-_.---_..__--- <br />� - . <br /> Remodeling umJ/n, reza(ring ):------- ,<L-. -------------------------------------------------- <br />� <br /> ------------------............ --__--_-__'__-__..__..__._---� . -------------------------------- . <br /> . x�- --'-----' <br /> ------------------------------------- ----------------------- <br /> ------'~-_----..-._------------------------------------------------------- _---'----------------------------------------------- <br /> ------------------------------------ -------- ----------------------------------------------------------------- .---..------------------------------.......1--------------------------------------------------- ` <br />� | this ' <br /> ordinances, State 1�ws, and'rules and regulations of the San Joaquin Local Health District. <br /> BY:..........---...... ............. -'---'--'—'---''---'-----r'"p'--'---------------- ' <br /> ��f plan, m� lot'.��mf�� , , <br />� ' ' - � `� ���� in relation to wells,- buildings,- - --` can be placed,on reverse ~~_r � <br /> " <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED -'l 1' DATE �� ����� -- �� �� ' <br /> -� - _'---__----- __-.--_-_ _ - ._� .� _-----' � <br /> REY[EVVED BY' � � ,</ <br /> —'---'--�--' —'-----'--'''-'-'—'--_.-__.'---.'-_ DATE_-'''--___.___________._.. � <br /> 8U|LD�N£� PERk4|T ISSUED � ` <br /> commeln <br /> Alterations and/or Ations:--- <br /> �-e <br /> ----- .................................. --------------------------------------------------- -------------------------------------------------- - ------------------------------------------------------- � <br /> --.......... ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ --------------------------- ` <br /> FINAL INSPECTION 8Y' / ^� Du�' ~7 -- | �� <br /> . -�,^�' �`'"�°` '_-'-'''-' -'��--'^-'�'_----------_'-'-_-''-'— <br /> // .. ` <br /> � SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street nnmWest Oak Street 124 Sycamore Street 20wWest p1h Street <br /> Sto^w*n.C*nfo,nia Laa/'cwxf","/" Manteca,California Tracy,California <br /> ES REVISED "'"° www'^' mL^" <br /> � <br />