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� <br /> APPLICATION FOR SANITATION VRMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Oppl�ication��'sereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This ap lication is made in compliance with County Ordinance No. 549, 717- Z-00-2-( <br /> . ^~...^... . Name---------------------- ����.-.~.-.~~~~------------ Phone-_-----__- <br /> |nsta|lationwill serve: Residence Apartment House 0 Commercial [] Trailer Court [-] Motel [] Other [] <br /> Number ofliving units: ../- Number nfbedrooms - �--- Number ofbaths j-' Lot size ----- --.----.- <br /> Vvater Supply: Public system E] Community system [l Privo+e K Depth to Water Table -------- ft <br /> Character of soil to u depth of 6owf: Sand E] Gravel [] Sandy Loam [] Clay Loam El Clay El Adobe Hardpan [] <br /> Previous Application Made: Ye, [] No b4- New Construction: Yes.WNo D <br /> z» <br /> TYPE-OF INSTALLATION AND SPECIFICATIONS: Y^ <br /> /N� septic tank m, �e,���m| p�,nn�HoJ R pu6||cue*o, 7oa°aUa6|e ��6�n ��� f*et) ^ <br /> ` .`� <br /> Distance from nearest well Distance from foundation Mutoriu| � <br /> Distance from founclafion-J-0- -----Distance to nearest lot line------14P. <br /> Distance from nearest well 4 --- <br /> Type 7 filter material 01&jV4r�_.rWy <br /> Seepage Pit Distance to nearest WeU Distance from foundation--------------------Distance to nearest lot |i <br /> F-1 Number of Lining riu| Size: Di Dept k---------- j <br /> Cesspool: Distance from nearest wefei | <br /> El Size: Diomnfec-----��--��—_Dno+��-----.--_--------�ou�� Ca <br /> Privy: Distancef=�� nearest weU'���-��� -�-_'_--'''-''Distance from noo,e� building--'''''-'_---' <br /> El Distance to nearest |o+ |ino--------------__-__.---__.-__--_----_---------- <br /> Remodeling and/or repairing (6a,cribe):''''' ------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- _--'_--_--'_------.---' <br /> ------------'-----------------------'---''-------'--------------------'---- <br /> '-''-'--._---'—'-�''-''-___.'--___'_______-'_-_--'''__.-'--.'-'-_--'------'---'�-''�-'�-�� --- <br /> that He work will be done in accordancewith <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> &410� <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 /> --------------------- ------------------------------------------------ -------------------------------- ------------------------------ -------------------------------------------------------------------------------------- <br /> ---'---------- ---------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------- -------------- --------------------------------------- -------------------------------- <br /> ----_-------_-----------------___----------_____-- �_____�_�__��____���__�_���___��_ ��_ ���_��__���� <br /> � <br /> [� <br /> FINAL INSPECTION BY:--------------- R�-~------- 0mt�----*^f��-.f� ------------ ------------------------------ <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /w South American Street 300 West Oak Street /32 Sycamore Street ow North 'C' Street <br /> smckm". California Lodi. California Manteca, California nmov. California <br />