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/ <br /> APPLICATION FOR SANITATION PERMIT Permit No4,A---------1------ <br /> (Comp(Complete <br /> lefa in Duplicate)--' Date Issued .5~-1..�.ar~� ' <br /> , Application is hereby made to fhe San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> This japplication is made in compliance with County Ordinance No. 549. ? <br /> � <br /> � /~�} --'---'----'-__.______.__._-___________________________ <br /> Cnnac�/o Nome ��= ' <br /> .--------_------- -- - ---- - -- - - Phone-------------_--.--.. <br /> tallation <br /> ill <br /> / -- -' serve:_ ....~~. <br /> ic r?-_A�parfment Housr�-Commercial-E]--�­Trailer Court L] Motel 0 Other E] <br /> N umi7er of living units: -- ----- Nu�ril�'er of bed room"sbt*C91_Uum ber ---- Lot size <br /> Wafer Supply, Public sysfem Community system 01- Private [��Depth to Wai6r-Ta16lc -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam F] Clay Loam Clay [_1 Adobe Hardpan <br /> Previous Application Made: Yes El No [��New Construction: Ye,V1 No F-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: N, <br /> (No septic tank or cesspool permitted if public sewer is available w-if hin 200 feet.) <br /> resi <br /> � Septicfrom ___ Distance <br /> .`". of <br /> o � "o "pv,tnnn�-_. w�'''�� o�a_'_ ��$,r.3- L�uid �upj6'''-�V��--�-Capuc�y.-' <br /> 0 �D ` , - / J���/ <br /> �: Distance from nearest �|'��-- �� �� f�n��' .��n� � r�n� � line ~�'-�-- <br /> ''EN �� , U ~� ` ' <br /> gfh Seepage-P�f: Distance to nearest well-----------------------Distance fr;;� fo,"unclation-------------------- Distance to nearest lot line--,,,, <br /> -- Number of pits------------------------Lining— ^~'`''~' Size: "'a'`=e" Depth � <br /> - -------------------------------------------------------- <br /> � -"°="""�xng and/or ,���/nng |�e` n���'-''.-' -- -''-'''- <br /> '--'--'-_.'__'-'''--'--'--_--''-_--_--- �-'---�---�--''-'''_-._-`------------- <br /> --''----'''----'-------------'--------- <br /> I hereby certify that I have prepartid fW'apIpIicAfio-ha6�'fh-& the Woik-will'be don in accordance with -S--a--n----J_o__-a- <br /> ' � -v,umonc=sState laws, and rules and ''anom�uv�uemD7s+r�}. <br /> ��n�6\� ��J� ^ <br /> . ~ `_----_-.-�-~,~~.-_.~ ----------.-----.----It'-------(Owneran6/n, Contractor) <br /> (Plot plan, showing size of lot, location �f system in relafion to wells, buildings, efc., can bZ placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> '''--'--_''_-''---�-''''-_. "'" ---------~~=` <br /> BUILDING PERMIT ISSUED i--_---�__._-------._---'-__-._-_- ' <br />| A�eraHnns.and/or <br /> ________ ---------�-~._'--..-_--.__.- _ -_- �-� -'_---'- <br />. -�''-'''_'' -''''-'- <br /> '___�________.____��_�~�L.�� ________~°�� ''--' <br /> '-_''-''''''_'''_'''''''''-'''-'''-^'--'''-_''''-'-''--'''--''''----'''-'''---_-----^-_'/�.�� � <br /> --''----'--''--''-'-^-'''-'''^-'---'''-'''---'-''�--''''_''''---''--'--'''-''-'''-''_'- <br /> ' -------- <br /> FINAL INSPECTION BY:----------- <br /> -------------------------- DateSAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /mo� ��" S� � �� �ks� /� ��� s� oww� '� s� <br /> smo�"\LS-9 2M California . Lodi, California Manteca, California nw"n �°|a","� ` <br /> °d W-z|no <br />