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t / HON FOR PERMIT �nnR No` - � <br /> ;n <br /> r°~'ple'e D°p~~'~/ <br /> Date Issued -I/ . <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct a d <br /> U+h k herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN LOCATIO�N_-------jov- --- ----- ----------- - ----------- <br /> A66mss----------------------------------------------- <br /> ---- ' '---------'-'-'----------'---'-'---''-------'-----'- <br /> � . � ��� �� <br /> Contractor's Name--- <br /> ^ �.- -..��.��.����-----.-----_------. Phone-^��"�-°"--'---- <br /> Installation will serve: Residence [] Apartment House 0 Commercialfig—Trailer Court E] Motel [j Other L] <br /> Number nfliving units: -------- Number nfbedrooms -------- Number ofbaths Lot size °_-'_' <br /> Water Supply'- Publi6 system D Community system El Private to Wafer Table &!*_ ff. " � f <br /> Ch��ctormfsoil to a depth of foe*: Sand [] Gravel E] Sondy,Loam [] C|oy.Loam [] Clay [] Adobe 23-'_Ra,6pon [] <br /> Previous Application Made: Yes - No U�-' New Cnns+ruc+ion���oo 25' Wo <br /> -- -� <br /> TYPE OP \NSTALLAT\ONAND SPECIFICATIONS: <br /> ^ | <br /> (Nn septic tank or cesspool permitted public sewer available*R6in 200faefJ , <br /> 3ap+lc Tank: Distance from nuuresf weU...�.���-'4V|,fu de' -Mufnnn/ .��-----------..z--- <br /> �N No. ofconnpu�monf,--. ��---..Size---^I-��.��.$��.."�0���id d eA+h-.-����.^--Cupu�+y.. �u����.-- <br /> -_` t � <br /> Disposal Field: Distance from U D�+ �o �tovnu� <br /> Nvm6*, of lines ~-6 ..- Longm c� vncxxnn�e ��- cxrnuncn-.�.����-----.. r� <br /> ��- Tvpenf �Kermnfe�aL.~�«�--- ��a�'Depth offilter material 1-3..._Totu| length---- ----------------------- m <br /> Seepage Pit: - Distance to nearest .oL'-''-'.-Oistunce from foundation-------------------Distance to uoon*st lot line-'--'--- tr <br /> [� <br /> Number oF'pits- Lining material -- Size: Diameter Depth ~ � <br /> fr <br /> Cesspool: Distance from nearest weil-------:---------OFIA 41 <br /> -~~ (- <br /> `--'--------''''------------'-''� --�e�-------��������� -- - - ' <br /> .-_--.-----.--.__---.-__-----._-'_._--_-_-'.--._-____..____--__-_.-__'--_--- <br /> ---------------------------------------------------------------------- <br /> -I,here6y certify that I have r-ed this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat s. and rules and regulations of the San Joaquin Local Health District. <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 /> "..L.C,..~. ACCEPTED ~. -._----,'-- ___-_-_. - �T <br /> REY|EVVGD 8Y.'-'---_'_-.-'���/��-'-'''---'^�-- ux/� . <br /> DU|LD|N�� PERW|T |SSUED_--��_.--'-_---_.�~-_-_-.---_.__-' ua/�.-°~ -__'-_-_--__' <br /> Alt=rmti*ns and/or reowmmendm+ons:----. ------------ ----------------------------------------------------------------------------------------------------------------------------------- <br /> _____________'__�-------------------------------- -------------------------------------------------------------------___-----------------------------------------------'__................... <br /> ^ <br /> _-.'--'-'-'__.''_-.'--.`-__-''---'-''--+---'-'''-_'--''�_'''_--'''-'-_-_''-''----''__.''-''-- <br /> --------------------------------'--'---''-''- ----------------------------- '' -------------------------------------------------------------------------------------------------- _--------- <br /> .--'----''''-''�'_''-----''''--�--------------------------------------------------------' ----------------- --------�'--'-'''-''_-'''-'''''-'-''_-. <br /> . <br /> "�� <br /> � <br /> �N � L1NSPECT|(�N '0Y' -------------------------------------- Dut�-.y^.. ...�r����-.-���-� ------------ ------- ........... <br /> SAN JOAQU|N LOCALHEADH DISTRICT ` <br /> / <br /> /ao svum American Street amWest Oak Street. /sm Sycamore Sfreof uw m"*h ^o^ Street <br /> Sto"H=". California Lodi, California ' Manteca, California Trn"'. California <br /> ES-9-2M ; . Revised W-2100 <br />