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\\ APPLICATION FOK -ANITAT[ON PERMIT Permit No. ...7 mfw in Qwp|Y�mfm1 ^- ' Duto |smed -_- ----/S�� ' LocalT�plica4ion is hereby made to the San Joaquin Health District for and installthe work herein described. is application is made in f compliance with County Ordinance No. 549. ,~~ '.~~.'E~~ AND -__ ...-' --------r.....--------'----'------------'----7'— *� P6on�..81�)^.. .4/ '~~'`^^---�--'-- - ~----- ........ -- ---------------------------------'- -------------'--------------' �~ Contrm�o/, Name ------------------------------------------------------------ phona-4A----a=_jl��- Installation will serve: Residence Apartment House [I Commercial �Trailer Court Motel [j Other [j Number ofliving units. -I-. Nun`be, of bedrooms Number of 6ath� -|.. Lot size -----kp-,-,"J.L--------.- Water Supply- Public system 0 Community system Fj Private tj��Dopfh to Wafer Ta6|oit. Character of soil to a depth of 3 feet: Sarid Gravel [] Sandy Loom [] Clay Loom [] {]vy 0 Adobe ED'Hardpan [] N �- -` �=�� Previous Application Made. Yes 0 N �� New Construction: Yes y�' /vo 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (Nm septic tank or cesspool permitted if public sewer is mvml|a6|e within 200 feet.) Septic Tank: Distance from neo,n`f well-----------------Distance from foundation--------------------Material ----------_----- Nu. ofcompartments--------------------------Size--------------------------------Liquid 6eF�h--------------------------Capacity-----------.--_ D;opnw| Field: D;stonce from noumot well----------- -----Distance from foundation--------------------Distance to nearest lot line------------- Number of lines-----------------------------------Length of each line------------- Width offrench'-'---'-''-''_- Typa of filter mu+eriaL----.---.Dopth of filter mo+erioL.A.l0r-----Totm| |ength-.--_-----.----. S -- Distance to neuro, well --!��.'.. from .. / _Distanco to nearest Number of p|�-''J�-''-Un�g mut �u| Size: Diameter--------3/ --Deoth -'��n�~ Cesspool Distance from nearest well '-'---Distance from foundation--------------------Lining material -'-_--_--'-''- [l Size: Diameter.------- ------ ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well '''-''''-_'---''-'_-Distance from nearest building------------------------------------------ ElDistance to nearest lot line`-------------_--..__..__-.__.--__-_---_-_---.--' Ramo6o|ng and/or nepoir�ng (describe):' ------------------- -- - ---- ------1xP_,.0--------a------------------i---------------- --------- .____-.___.-_----'----'--'--_.---'_.___.._--__---_-�-__-_-_---.-__-------._--__. ----------'''----'------''--'---''---''--''------'------'-------'--'--''---'---''-''---'-' .______________-_----_-------_--..__--_.-_--_---_-__---_-_._-_------------.-_.---.--- | hereby certify that | have prepared this application and that the work will be done in accordance with San Joaquin County n -' nnJinanmoo. State laws, and rules and regulations of the San Joaquin Local Health District. ' --------.------- and/or Contractor) \ -r ------------------.-_------/Tiltlei.- ------------------------------ (Plot plan., ---------'(Mm+ 9|an. showing seiz f ]of, location system in relation to ~oUo buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------------------------------------- A|twr n6/*, rocommen6a+ions:-------------------_--.-_--.---.-------.-----.-------_-.--- --w-'.-m.- ---------_ -.--._---_'-'_..__. -----_-_' '��,. � � '''-'''-'''--_'--'''---''----'--''_-.'__''_-'-''-'__.__----..__-zp/- ----------- '--'�� x -=_-' '--'-''-_-'-'-_''-'''''.---''--'-'''_''''-''_-_'''---'-''''-''''--''-'''--'''-'-''---'-'--_ .-''-''--''-'--''--''''-_''_'-''_''--'''-''---''---'--''''_''---'-''--'-''-''-''-'--'_-- FINAL INSPECTION BY:---' ' Dut�..-3_/ L/�� -'_-'-''-''----_- -- --------------------- SAN JOAQU|N LOCAL HEALTH DISTRICT /30 South *m°ri=^" Str**x somWest Oak Street /sz Sycamore Street 814 North "C" Street St" kt"", California Lodi, California Manteca, California r="y. California ES-9-2 M ' n=/,°J W-2100