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~6 � <br /> ��»���(���'����� F{�� ��^y���kT����� ������� P*n»� N« ------------------------ ` <br /> � . <br /> ` �n ��nkcutm -S- <br /> Date(Complete Issued -�-'L_---'/ <br /> ' - <br /> Application is 6om6v made to the San Joaquin Local Health QistHcf for o permit to construct and install the work herein described. <br /> This application is made in oomo|ionce with County Ordinance No 549 <br /> JOB ADDRESS- AND ----------------------------------------- ' -- <br /> Installation will serve: Residence j�4artment House Commercial [-] Trailer Court [] Motel Ej Other E] <br /> Water Supply: Public system f;J�Commurfify system E] Private V1111k,Ilepth to Wafer Table.Z-/-,- it. <br /> Charader of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay LoaClay E] Adobe pan � <br /> Previous Application Made: Yes E] No 5-1_<1 Construction: Yes E] No U�-~��A/VA. Yes E] No <br /> TYPE OFINSTALLATION AND SPECIFICATIONS; <br /> (No septic fanko,'cesv9m,| permitted if public sewer i^ available within 200 feet.) <br /> ~ <br /> Septic <br /> Distance from noure,f well---------- .D|stuncofrom found&inn---.----Material ---------------.- <br /> - � <br /> No. nfcumpv�mon�---.. --------------------------------Liquid �aof -..!------'Cupu6t�------- <br /> ' .� � <br /> Dispos | Distance from nearest well �o foundo <br /> ' --------- <br /> Number lines � �� � � | � � <br /> --'' ------''^~^~��� `` ^^ '' ^~^ <br /> Type offilfxr mntur|oL_V'6__!7~~�_ 'Dupt of filter m�+e�*L-�/.�[.�-'T�.t | |eno+ '_ <br /> ,��!.�.----_-�- <br /> - <br /> D�| nc= to nuvna� woU--`- _-' Di�once from foundation <br /> --------Distance +o n000flot line-'6 <br /> Number of pif, .-I-------------- <br /> Lining »mo+eriaL' . -Siz;: Diomr+p,-a_j----------Depth --------------- <br /> o <br /> '''- <br /> ' <br /> � <br /> Cesspool: D��noa fn �, . <br /> 0 <br /> Size: Diameter'''---'-''---'-_Deo+�.-------'-''''--''''--Uoui6 Copmc��-'_-'--'-',go|,� <br /> . � <br /> Privy/ Distance from nearest welL''-''''--''--'''�'--Dsf°nca from nearest building --'''-''--_''-'-- <br /> D/stanoa to naanyd lot |inu--------.- _ ._ --_--_.--.. <br /> ' Romodoling un�/o, ,apoiring /6a�c����---_ �����-.^�k���N���n _._-._.__'' `^ <br /> _--_.'__-__.''_--_.'___'''___-_--'--__-'_-.--____'-----''-'-'--'--'------''--''-'--''--''-' <br /> .--.-.---------------.--------------.-.------..--.-------.---------------.------ <br /> '-----'--------------------'--------------------------'—'-------------'' <br /> work will be done in-accordance with San Joaquin County <br /> ordinances, State laws, and ule and r latio s of the S Joaquin Local Healf istricf. <br /> (Signed)------- <br /> (Plot plan, showin z of lot cation of system in relafion to w Ils, 6uilklings, etc., c be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- ---------------------- ---------------------------------------------------------- DATE-.--..___.--.__-.__--. <br /> ------------- -7--------- <br /> ----------- ...........I----------------- ---------------------- - --------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------ --------------------------------------------------- -- --- --- -- -------------------------------------------- -------------------------------------------------------------------------------------- <br /> 46- <br /> " � <br /> '- ''' ''--''---'''--''---''''-'''-'-'-'''--''---''''-'''---'--'-- <br /> '-lr---'r--'''��-' _�_ ______________�________________________ <br /> � ~_� <br /> FINAL INSPECTION BY:.. �� � Dote----.----.1-----_------------._---._ <br /> � SANJOAQU|NLOALH6AlTHDISTRICT _ <br /> ow South American Street avoWest Oak Street /yz Sycamore Stree814 North "C" Street � <br /> m""kt"". California LoJ|. California Manteca. California nam^ California <br /> sS_v-«M n°"/,"ci ;'sr ppzo. <br />