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r <br /> \ <br /> � <br /> ���LA�������� F���� ��^y���4������ ������� Permit No. <br /> - .. <br /> ' ;n Om��afel <br /> (Complete Duplicate) |uox»d <br /> hany6y mo6o +o the Son Joaquin Local Health District parm� +ocono�uxtand indaU+ho\w!�'6o,e�n <br /> ' T is application is made in | <br /> V7R-------- ------------------ <br /> Installation will serve: Residence 20"Apartment House E] Commercial T-1 Trailer Court 0 Motel Other 1P <br /> Number of living units. J---- Number of bedrooms _43- Number of baths ----L Lot size ------------­­------- <br /> Wafer Supply: Public system F] Community system El Private Er.-Depth to Wafer Table ff. <br /> Character of soil to m depth of 3 feet: Sand &'OGruve E] Sandy Loo Clay Loam [] Clay [] Adobe [] Hardpan [] <br /> Previous Application Made: Yes F] No V' New Construction: Yes 2~ No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted R public u is avu3u6lm within 200 feet.) <br /> Se nk: Distance from nearest well.....��.��-Diofun�� | ��-0 <br /> c�r <br /> No. �fcump�,�m�n�---'�� .--..Siz�-.���ln���..$�.'_ u��x \Capacity �~��� , <br /> u��» ' ' ' ^�^^� <br /> ----- <br /> Disposal Field: Distance.from | Di6n foundation Distance to nearest lot line <br /> ��- Nvm6u, of lines.-. L k of each line----------- 6 of �enck--. ����' <br /> Type ofCter moforiaL*&�./�0�A@�5epfh of filter mot*r|o|--���.��--Totu| length----..�.^��----------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance +v nearest lot |imu.-_._- <br /> El Number of pits-.'-_''''-L|n|ng material-----------------------Size. Diameter_''-'''-Depth-'-��-'-''-''- <br /> Cosspoo : Distance from nearest well-'-_-''-D;stunco from founcl°6on--'-'--Lining motoriaL''-''-'--._____ <br /> [] Size- O|ume+vc-------._---------.........Depth----------------------------------- ----------------Liquid Capacity----------------------------gals, (/14 <br /> Privy Distance from nconu+ well---------- ----------------------------'-Disfanco from ne­aredf building'''-'''-_----`'_-'-----' <br /> D|stance to nearest |o+ |inr.-----_------_-._._..__--_--_-____________.__� _ <br /> Remodelingand/or repairing (describe):-------- -'''-'�---------------------------------------- -------------------------- -------------- -------------------- _____. <br /> --_..--...-__.____..-___--_-___-_--.__..-_---------.-_--_--__-.__._---_..__.__-_------- <br /> ---'--'---'-'--'''--'---'--'----------''---'------'--------'--'--'-------------'---'' <br /> --'--'---'-'--'----'--'-'-------------------------'----'-------'---------' <br /> I hereby certify that I have prepared this application a9J,.fh.af the work will be done in accordance with San Joaquin County <br /> ordinances, fat ws, and rules and regulat�fions :i4f,the Sa quin Local Health District. <br /> ..............A <br /> ------------------------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. DATE------ <br /> ------------------------------------------------------------------------- ------- -------- ------------------------------'--------------------------------------------------- '��`�������'� <br /> '-'-''-'----'''-'�--'---''''-----'-'—''-''''-''---'''-'''-'''' ''-'----'-''--''-' <br /> FINAL INSPECTION BY:--'--A-''--�--'''-''-- Dofo'--'lo�1 0 '' <br /> wr~-'' ------------------- <br /> SAN <br /> -----SAN JOAQUUN LOCAL HEALTH DISTRICT <br /> /a/ South American Street 300 West Oak Street mo Sycamore Street 814'Norf6 "C" Street <br /> St" e"". California Loa|, California Manteca, California r="» California <br /> sx--9-2w m°./,"d vv'u/oo <br />