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V-11" <br /> - <br /> APPLICATION FOR SANITATION PERMIT Penn7+ No. - <br /> /��m�|�fw in Ou�k�af� <br /> � ` Date /suuv6 --Applica4ion is L.��u-.�-� <br /> \ <br /> hereby made to the Son Joaquin Local Health District for u permit to construct and |n,toU the work heroin 6esrr|6aJ. <br /> This |i iis Je in compliance with County Ordinance <br /> Own;r's Nami -------- ----- - ----- - - ----------------------------------------- <br /> -------------- <br /> Qe�� - <br /> Installation will serve: Residenc Aparf� Atse Fin Corn rci 0 Trailer Court L] 'Motel L] Of her 0 <br /> Number of living units: Number of bedrooms --- Number'of baths _/--- Lot size ---------------------- <br /> Water Supply: Public system'Vr Community system [_1 Private E] Depth to Water Table K-2 ft. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel Ej Sandy Loam El Clay Loam 0 Clay El Aclobe)< Hardpan 0 <br /> Previous Application Made: Yes E] N 0 New Construction.. Ye No E] <br /> X S4 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.-.-�------Distance from foundation--- -1---------------- -------- <br /> Disposal Field: Distance from nearest wO......U------Distance from foundation----- Distance to nearest lot line----- <br /> epag <br /> -----------Distance to nearest lot line------ <br /> cl� re <br /> I hereby certify fha f I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,, and rules and regulations of +he San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be ppM��_4_don reverser. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------------------- ------------------------------------------ DATE-------------- <br /> REVIEWEDBY------------------------------------------------------------------------------- ------------------------------------------ DATE--.__.i_-�..��-.~_/_.__.-.. <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE''--''_-'-''--'-'''_______ <br /> Al+a,mtinnoun6/or ,acomnmen6a+ipno:--.----._'-�^..---------.---..----_-__.--_-_-___.___._______________ <br /> -------'-----'--------'-------'-----------------------'---'----------------'-' <br /> --------------_---_------__---__---------___-----_____---_������__--___-----__---------_-------__-----___---___---__------------_------'_-----__�--__------'------_---_---_ <br /> ----`-`--`--`-`-``--``-`--````-``--````-``--'``--'``--``---`--``—````--``--'---`--`-`-`--`-- <br /> -'-'-'--_-''''-'-'-''''--'--' ' ---------- ------------------------------------ ---------- ---^'' <br /> _' r'--'-''----'--' <br /> K <br /> FINAL INSPECTION BY:----------------------- Dote-'-_''`--'''-'-'''-'''-''-'-'--'-'' <br /> SANJOAQU|NLOCALHEALTH DISTRICT <br /> 130 South American Street snoWest Oak Street |nuSycamore Street m4North ^c^ Street <br /> s+v"kt"°. California L*d/, California Manteca, California rmxv. California <br /> ' <br /> sS-9-2mn=/,°d w-x/oo <br />