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^ . <br /> Pm�n� <br /> � ' -APrL|���� � ��� �����T"�� ����� <br /> �� . <br /> � Date Issued <br /> Duplicate) ^ <br /> /;L � <br /> Application is hereby mode to the Sun Joaquin Local Hnu|fh District for u permit to construct and install the work herein described. <br /> . <br /> This U tl is made <br /> in compliancewith County Ordinance No. 549 <br /> JOB ADDRESS AmuuOCx//Om ^ - <br /> � --------- <br /> Contractor's Name_-' -- - , . <br /> `~ |ndaUe� will� serve: Residence �� Apartment House [] ��ommorCourtMotel| �� Trailer Court �� Motel [:] [)Hn» <br /> o - --- <br /> . Num6e, of |iving uo�+ '» Numberofbedrooms .. -. Number ofbaths --- <br /> ^ Lq+ size <br /> .�� <br /> � <br /> Water Supply: Public system 54 Community system �� Private [] Depth to Water Table <br /> ..-.. ft <br /> � 6 <br /> Character of oo|| to o depth of 3 6sef; Send [] 6n:vn| LJ Sandy uzom LJ Clay Loam LJ Clay LJ Adobe ,~� Hardpan [] <br /> Previous Application Made: Yes [] NoNe. Cvns+ruc+|on: Ye, N moE] _ <br /> TYPE {JPINSTALLATION AND SPECIFICATIONS: ~ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tonk: Distance from nearest weU-.--�-.-Disfon�c f _ fvun�Vion.10- <br /> . kp+e,io| <br /> -' <br /> No. of ,ompo.-_ _ . - .. _ . i6 depth *41' Capacit� <br /> � <br /> � <br /> Disposal Field: Distance from nearest weL � '_-Distance from foundation-10t« <br /> --------Distance to nearest lot |���f-7--- <br /> v� K " Oao+ of |+er m�tun ./�. Total |enotNumbe, of lines - Length of each line_-'J�/�--/ -._V �t of k <br /> ;,- <br /> Type of filter matea �4 ___-i --------------------- <br /> Seepage <br /> -----_-_Seepvgu P8: Distance to'nearest welL--.-'��-Distanco from foundation-. Distance to nearest lot line----------------- <br /> .� �[� N <br /> beof �� Lining �;��| SizeDi4i �eter Depth <br /> ` Cnsspuu|: D|,fooca from nearest we|l----------------Distance from foundofon --------- Lining material-------------------------_---_� <br /> [] <br /> Size: Diameter ---------Liqvid Capacity--------------------------'gals. <br /> �� <br /> Privy` Distance from nearest well -.._----____---'Distance from nearest­ building----------------------------------- D <br /> Distanceto.nearest lof line----------------------------------------------------------------------------------------------------------------''-'�'--''''-' <br /> ' Rumode�ing and/or repairing (describe):---.-_-----_--------------------------------------------------------__.__.-___-__...__--_---. <br /> . . <br /> [ <br /> ------------------------ <br /> -__-_--_-__.-___.--__.---__-___--'___'--.-----------''-'__-_.'-_.-_-''-----'�--. <br /> , ------_----_-_-.-------_----_.----------'_-_------_..-----.-_-_---------.--_--_--_-------_.. <br /> ----------------------------------------------------------� ----------------------------------------- ���------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and thatthe work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ,�=--'---- -----' <br /> � <br /> ------------------------------------ <br /> By:. '—''-- <br /> � u| �q�(Plot plan, showing size � k� �a�n of relation to wells, 60etc., can 66 placed on reverse side). (�� <br /> � <br /> FOR DEPARTMENT USE ONLY <br /> VV <br /> Alterations and/or en6a -'- -----'' --''-'---'---'----- <br /> ----~^-''^~--~^'�^-'-----'-7�^ '---� �- --�y''~-----^------- ----�----''------'�---''------ <br /> _-_.'_ ------------------------------------------.'~~-'''''_-'''-'-''- _-''--.''-''-'''''-_-'''_ '-_.'--''_''---'___--- <br /> ------`--------------'`-----``��-----------``-------`````-------``��--```---````-------```---------`�``-------```------``-----``------'-------```-----`------'`-----`--------` <br /> --''_-'_--''---'' ' -'-' �-'''- ------'''''-���'--''''-'''_-'-_-''''----'''_-'''- <br /> ' �N/\L |N5PE��|(�N BY�.. ----------------------------------- <br /> SAN <br /> ���--_. Dot�.��.----....�._��-����'_-'___.._._.. <br /> . SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /»o sv"m American Street aomWest Oak Street /so Sycamore sa=.* ow North ^C^ Sfr"o° <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ' <br /> ES-9-2M 8-5/ Revised W-z/on <br />