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APPLICATION K� .� PERMIT Permit No. <br /> (Complete in Om��a+e <br /> \Y� !r ' ' Du+� Issued -- <br /> u .is hereApplication <br /> by he, 6v mudo to the 3unJoaquin Local HealthHo� � Qist6for� o ponnif to construct and installinstall ^ described.+6�~or ��ro�application / <br /> This u�� �applicationisnm6o in compliance with County Ordinance No. 349. <br /> Contractor's Name-- P h <br /> Installation will serve- Residence A arfmenf House E] Commercial E] railer Court [:]' Motel Other El'f <br /> Number nfliving units: /r- Number ofbedrooms Number of baths ^/.- Lot size -. ,^ �r��-.�-�--.- <br /> Water Supply: Public system Community system [] Private E]x Depth to WuhmTobl-4/4' ft + <br /> Character of soil to m depth *f3 feet: 5un6 [l G,u,e| E] Sandy Loam F1 Clay Loom [] Clay F] AJn6° o�� Hardpan [] � <br /> Previous Application Made: Yes [] N~ s�^ New Construction: Yes'K [� A/VA. Yes �� Nn~�?`' ^ � <br /> . � --'�� Np� <br /> TYPE OF INSTALLATION AND 6PEC|FICAT|[JNS, ' <br /> (No septic tank mr'*nsspon| pormlffm6 if public sewer is available within 200 feet.) <br /> Septic Tank: ^ Distance from nearest well-----------------Distance from foundation--------------------Material ------ ------------- <br /> -- ' <br /> Nu of compo�mnnt�--_--_-Sba--_---.--_-.-�qui6 6eA+ __-----.Copodt�.-- '`-'- " <br /> Di ' Distance from novn,ot weU_----Di�ance from foundation-------------------- to nearest �t ||no. � - <br /> Number of |ine�.-'__-- _---Leng+ of each line----------------------------- of french- <br /> Typo of filter material _-''-�-'''Depth of filter material----------------------Total length-------------------------- <br /> ��---' ' <br /> See <br /> ` Mf� Distance <br /> to nearest voU,op-%=wV--_ Di---,-�{�-� - Distance to nearest m` / n <br /> --- <br /> Number of pits ./---_'Lining � ��r� Diomo+or- .�V-*-__Depth- <br /> ^ Vy+^ <br /> � <br /> Ces4zoo|: Distance from nearest well-----------------Distance from foundation-------------- ---- Lining material--''--�_-' ' �j <br /> �] Size: D�mote�---__-._----Depth---''''-_'''-'''_-__-. i6 Cupac�y -�-._-----''gals. <br /> -- <br /> Privy- Distance 6nm nearest well -'''-'''-_.--'--'--.-Distance from nearest building----------�---'-_ - [� <br /> LJ Disfaoce to neoncsf lot line` <br /> ,15 <br /> .^_* -»«-_ ''-- (u .b ) ?- 0. <br /> -'' '---_-^.-__-~--__---.--��_'_�-- - ,-__ a __________. _�--''-''--''-'~ --_- _--_-'-. --_^'_.__-------'--.-----_------.------_------.---.---' , <br /> hereby <br /> ordinances, State laws, and rules nd ffligulafions,0 the Syr(Joaq i Local Health District. <br /> (Plot plan, showin- t, c ion of system in relation to wells, buildings, etc., can be ace -:d-------- ------- <br /> FOR DEPARTMENT USE ONLY | <br /> APPLICATION ACCEPTED BY.........-�^.��^����-------------------------------------------------------------------- DATE-.. ~ <br /> REVIEWED BY--.--�-._-------_�.-'-'_-'---�-_-'''_-.''-'-'-' __ '--�''---''--'-- <br /> BUILDING PERMIT |35UED.--_-..!--'_-_-_.--_--_--_.--__--._-_ -._-_� �-----'-'-----� <br /> Alterationsand/or ------------------------------------------------___ .. __ '-'--�----'' <br /> ' -- ''_-'----__.-- <br /> '---'-'------' �--^�+^'�--'+��:`^�^�--�^�-^��..�*x.__--_________._._ <br /> '-'__-'�-_''----_'-'''-_-''-_-''-'''---__''---'--_--_''-_.'''-''_-'--''�-_.----''---'_--'---''-' <br /> ______ <br /> --_-----__��-_-------_--------_-----_---------_��____---__---_--------- -----_ <br /> --_' ----------------------- ---------------- -------- ----------------:' _----_--.--�_. <br /> F|NAL |NSP"�..=w-^^ --------- ----m. Date-------- <br /> SAN <br /> -'SAN JOwQU1NLOCAL HEALTH D|STR1CT/g <br /> ..`y� <br /> ----------------- <br /> 130 <br /> ---- <br /> /oo South American Street 3ooWest Oak Street 132 s'"°m"=^Sfre° <br /> m* North ^c^ m,=m � <br /> Sfa"kfo". California Lodi, California Manteca, California Tracy, California <br /> ss--9-2w . x"~/=u 1-sr rp.Cn. <br />