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FOR OFFICE USE: <br /> -------------- <br /> ---AAPPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------- <br /> � <br /> ` <br /> ` (~==pe`= n Di't» Issued --- <br /> ------ <br /> t���L��� ~ <br /> - <br /> Application <br /> is'hereby made to the San Joaquin Local Hem|H` District for o permit +oconstruct'and install the work herein described. <br /> � <br /> This O f| is 6 in compliancie with County {}rdiNo 549 <br /> - 4..<, <br /> u. <br /> Contractor's Name------ -4------ -- - ---- --- -- ----------- <br />� ���nv� ��; ��n Commercial [-] Trailer Court E] Motel E] Other El <br />� -- Apartment -_- ^~ <br /> NumberofUvingunits: —/ Number ofbedrooms -�-__ Number ofbuHs -),- Lot size _- ------------------------------------------------ <br /> Water Supply: Public system mmnify system C) private E] Depth To Water TabletV5-'' ft. <br /> Character of soil to a depth of 0mmf` Sand C] Gr"avo| [] Sandy Loam [] Clay Loam [] Clay [] Adobe El=Ka,6pun [] <br /> Previous Application Made- (if yes''d. te-------------------- No [a~~~'Nm* Construction: Yes [] No A/VA. Yes [:] No <br /> TYPE OPINSTALLATION AND SPECIFICATIONS: <br /> /Wm septic tank or cesspool pZrmoYf+mJ if public sewer isavailable within 200 feet.) <br />^ <br /> Septic Tank: Distance from neoros+ weU-----.-Distnnce from foundation---'---Material ------------.---- K-�Y <br /> [� No. vfoompo,tm"en+s----- --------------------Size-------------------------------Liquid 6nF�h--------------------------Capacity----------------------- <br /> Disposal <br /> -___--Dispo,m| Field- Distance from noo,o, woL---_.Distancofrom foundation--------------------Distance to nearest lot line................. <br /> [-1 Number of lines-----------------------------------Length of each line-----'-'--._Width oftrench_'-'_--_.''_-- <br /> Tvpa of fi|fnr material-------------------------Depth of filter mo+uh*L_'_---Total length---___--_._----_. <br /> I Distance from founclation-Z Distance to nearest lot I' e,5-/, <br /> Cesspool:Seepage Distance tcF nearest well__x;� <br /> Distance from neuros weL..__--D�h�u» from foun6u�on------Un�g mo+=r�L---_--_._- - <br />| Size: Diameter Depf h----------------------------------------------------Liquid Capacity----------------_--------- <br /> nearest0 Distance to lot line <br /> ----------- <br /> g /or repairing ( j <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br />. +---' ' ' <br /> . hereby certify that I have prei$ared this application and that the work will be done in accordance with San Joaquin Court <br /> ordinances, State d r regulations of the San Joaquin Local Health District. <br />! <br />^ `~g'~~'- - v~~~'---v°�� <br />� <br />' ------------------------- <br /> By�-(Plot plan. showing size <br /> ` <br />. . � <br /> P3 DEPARTMENT USE ONLY <br /> APPLICATION -_ �- ~ ------ <br /> DATE <br /> . ---------- <br /> REVIEWEDBY'''-'__.--'�-''-'--'-''''----'-_''_-----'-_'---.--_ D�TE.'_'-_----'----_.-_.'_— <br /> OU|LD|NGPERkxiT ISSUED............. --------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations;--------------- --------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------- _--'-_-'--'---.--_.'-'-''_--'-'''_--_.'---'- <br /> ----------------------------------------- -_--------_------_-.___'_-_-''_.__----_----_------.. <br />. -------------------------------------- -------------` � ^ <br /> -''-''-''_.--'^'-���-''-''''�'�,-'�-'----''--'--'''_-''---''-''-'-'-''-''.�'--'--'--'-_'-'-- <br /> W­�!---- <br /> SAN <br /> ��N/\L |NSPE{�T|(]N 8Y:----� Da+o--- �z---' ----------- <br /> JOAQU|N LOCAL HEALTH DISTRICT ` <br /> vw0South American Street ` xpwWest Oak Street 12*Sycamore Street 2psWest 9th Street <br /> mo=m"^'California / 'Loa/.Caxfo=ia Manteca,California ,","v.California <br /> cs 9 nswsco a'up uw o'ao x`L^m <br />