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PIICATION IOR IMITATION 1IRMIT ­­�X .it No, <br /> _~~_~~�_~�_.~~-` <br /> wAP Perm <br /> 1 '7 �d 1 plefe in Duplicate) <br /> �1 : .. -. I -orn Date Issued ;;VY-5-13 <br /> � ThJoaquin <br /> application is made in 'p/� *�6qCounfy�]r6� N ' struct- -and '-- the work '~-'' described. <br /> ,~, ADDRESS ,, <br /> Installation will serve: Residence r[X.- Apartment 1­16use,�Ej Commercial E] Trailer C6urf C] Mote) [-] Other <br /> Number of living units: Number of bed r�ooms k!��Number of baths Lo�size ---6-4 x----- ------- <br /> VVa+o, SupplyPublic system Community system E] Private 0 Depth to Water Table40- ft. <br /> � <br /> Character- - soi-' to - --rt�-' ~ '~~'^ ~~^~ El ~'"`"' E] Sandy Loam E] Clay Loam Clay LJ Adobe Hardpan E] ' <br /> Previous Application Made: Ye's L] No New`Construction. Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , <br /> (No septic tank or cesspool ���� � pub� ��r � a��6� w�� 2� �e . <br /> � ' <br /> � <br /> e,plic Ta O�t nxe-f��` nuon=� we|Li_--..Distance fnomfoundotion----�_ MotoriaL'-'-_'''-''�-'--`_'_ <br />! No. ofp,rrp*rtmen1s-_---r--�Size­-----------------------------Liquid depfk------------ -------------Capacity-'-'-�'-- . <br /> Disfancelfr2om <br /> nearest 'Well'-l---Distunce from foundation--------------------Distance tn nearest lot line` <br /> ` <br /> Number "+. |�ao-__..----....--.Length of each |�v---.__-_-��6+ o[ �enc6--'_-_-' _-- ' <br /> ~~ � <br /> Type of filter mafo6aL'_-__--Dep� of ��ormufer�L--_---_Jvf | |eno�------------------------------------------ ~w | ' <br /> /Seepa e Pit: Distance-f6'nearest well-/,J(6Ni�'-----Dist�-nce'f�'om f6undation--;5,�_ �Qistp e <br /> Numb <br /> er of. ,��-_-�-�~=.._-= -__ria_'~-'^~` ,-..~. ~... e.=^~�°°-�---"ev.n«�­ --------------------- <br /> Cesspool: Distance from nearest well .__''-Distance from foundation-------------------Lining material '----.�----__- <br /> [] Size; Diameter--- ''?��'---'.-_--:_.Dept ''-'''''---_''''_''�'�_-.Liquid Capacity---------------------------gals. � <br /> Privy: Dis+ noefn,m nearest °eL',�.------'--''-''' --.Distance from nearest 6ui6ing-------------------------------^___ <br /> LJ D;stuncufn noavex+Jo+ lire--''-'r----.--_-.-___-__'-_---_-_.--___-__--____ <br /> ` »\ I ' <br />� <br /> Remodeling 6/o - <br />' <br /> I here6y certify f have prepared tki/applicafion and-fhat the work will be done in accordance with San Joaquin County <br /> ordinances, ormre lawya rules and.re 16lations ofthe San Joaquin Local Health District.� . <br /> (Plot plan, ��e ^ - ' '-x� - | ����--'---'-��''- <br /> ngs, efc., can be pla <br /> verse side). <br /> FOR DEPARTMENT USE ONLY <br />' APPLICATION^ ',~C`^ 'ED BY.' �'-'--'- ��|�--------- <br /> ' ' <br /> -- <br /> REVIEWED BY-_� � W­ i��-----'--_--'-_.''- -----'� -_.-----.-- '--''' ,V �_ '-- ' �'�--''-'_� DATE <br /> BU|LD|N£ PERW|T |6SUED_ <br /> ~-� ��-----'----- <br /> __ <br /> Alterations and/or recommendations:-------- ------me! <br /> ----1�fld-3---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> /30 south American street 300 West Oak Street 132 Sycamore Street 814 North "C" sfreef <br /> Stvokto . California LoJ|. California Manteca, California n*"r. California <br /> B-9-2w m52 Revised vv�/ou <br /> � <br />