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> <br /> ��������� ��� �������� ���� �n�� �� <br /> APPLICATION FOR <br /> (Complete in Duplicate) � Date Issued <br /> Applica-%n is mm6,v nm6e to the San Joaquin Local Heo|+6 Disthct foma.pn,mit to construct and install the work herein described. ^ <br /> This application is made in compliance wo-icounty Ordinance N <br /> |nstallation will serve; Residence E] Apartment House El Commercial .9—Trailer Court [] Motel E] Other E] <br /> Water Supply; Public system 2- Community system C] _' Private F] Depth to Water Table f*� ft. <br /> Character of soil to a depth of 3 feet: Sand [:] Gravel [] Sandy Loam E] Clay.Loam Clay E] Adobe 2:_ Hardpan 0 <br /> Previous Application Made: Yes E] No �L, New Construction: Yes [K_ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool per�mitfed_if pu-61ic ^ ` - <br /> wer is <br /> within 200 feet.) <br /> Disposal Fielcl-�41is-tance from nearest well---/1497-e_�Disfance from foundation---Af?�,I------Distance to nearest lot line-,-- <br /> 'rr~ - filter— material----- '~---- �A---'- of-filter- ' ~ length <br /> Snopogo Rt: Distance to nearest weL''---''--Distancu from foundation '''-''-_Distanca to nearest lot <br /> [] Number ofpits----------------------Lining material ._-_--Size: Diameter_.__-.—Depth---___.—.. <br />' Com000 : Distance from neunyst-~ell-----------------Distance from foundation'-''�'--Lining material---------------------------- <br /> Size: Diameter-- ------------------- ------------Depth------------------------------------- --------------Liquid Capacity----------------------------gals. ' <br /> �] <br /> from nearest building Pr�y:' Distance from nearest .oL-'—`'�--''--'--'—'D�f nu" � <br /> O�+unco <br /> +o nearest |o� |inv`-------------_._._—______�___._______.____ <br /> --- <br /> Remodeling and/or repairing /de,cr6e\:---------�_--_.__�-_--.__-_________-___-___.. ___ ' <br /> -_-'__.-_--''-_'�-''-'__.'-_.''--.''_-'''-_-_---'-_-'_-.-__-'_--'','---'__-.-_'__._-_--_-_ . <br /> -.—..^_.___..___—.__--______._--_--_-.._---__--___.- ___--__-----_'_-_-_--_-- <br /> ----__-.--_-__--_—..'_--._--,-..__...___.---__---_._._---_--___--___-_----. <br /> I hereby certify that I � fhaffhm ��r �8 6e 6 �na��wr�a with Sm Joaquin <br /> ordinances, Stafe,16W�) and rules and regulations of the San Joaquin Local Health District. <br /> � o <br /> . -.~^-.---_- -'-`~~~,.-,-`'--.—'---_'-- -- <br /> (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc.. om be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------------------------------------------- <br /> ---_.'''------'--''-''''-''''-'''--''—'''�—_-''-'_-_.'-_.''---''-'-'''-'-_---.'_-'------_-__ <br /> .—.----'---._.----._—'__----------._-------_.__..^---._---_--___-_----_—_._-__' <br /> —'--''---'''---''--'-''''--''---'--'--''-''—'-----''--'--'''--'''-''--''-'--'-'—'--'----' <br /> ------------------------- ------------ ----- ''_''- -''�� ---'''_'''-' ' '-- -' ----''-'--. <br /> ' <br /> �7_ ��RMAL !N5PBCTON 8Y�.�---- Om��_�'�--'_i ^*�_���___ <br /> SAN JOAQV|NLOCAL HEALTH DISTRICT <br /> mn south Ann°reca" Street 300 West Oak Street /32 Sycamore Street 814 North "C" Street . <br />� <br /> Stockton, California Lodi California Mwnt**o. California Tracy, California <br />� "S-°_"" `=°^^,°"". .`.~ � '� <br />