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FOR OFFICE USE: <br /> � PermitN� <br /> (Complete in Dwp��e) <br /> Date Issued ~ <br /> ----------- This Permit Expires I Year From Date Issued <br />-----Application is m6bv made to the San Joaquin Local Health District for m permit to construct and install the work herein described. <br /> This application ivmade in compliance with County Ordinance No. 34V. <br /> . ' <br /> JOB ADDRESS AND LOCATION ------ "�J� ~�/�.m���'��---..-----------..----'---------------' <br /> 41 <br /> Owner's Name-------------- -------- Phone__..-_------------- <br /> A6dm»os' ----------------------------------- ..__.___..._--_____-._-_---____-__-.--_--..-_- <br /> Contractor's Numa.--. ' ------- ----------------------------------.------------------------------------- Phone--''------'----' <br /> |nota|laflo" will serve.� Residence ^�q~-�purhnant House [] Commercial [] Trailer Court [I MotelMotel [] Other 0, ' ~ � '� /]--� . <br /> Num��r oY ||Wog units: -------- Number of6e6n,oms -��' Number of baths ..�-- Lot size -�z�/-��°��.��............................ <br /> Water Supply: Publi� system 2r-c-ommunity-systern 1i[] Private [] Depth +oWater Table ft ` <br /> Character of soil to a depfk%of 3 fee+.- Sand Gravel Fl��'�Sandy Loam 0 Cl LL� m [] -Clay [] Adobe <br /> Previous Applicafi�n Made: (If yes,date-------r ----------- No-[:] New Construction: es No [] FHA/VA. Yes [3 No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitted if publi sewer is availablewithin 200 feet.) . <br /> Septic Tank: Distance from nearest well-.--. 'Distance from founclation---ILI",-------Material �P4 <br /> ta <br /> uop""". ^~^' ^~~~^' -~-~--'~-~----- '—m -----n-- _'.�.....Distance to nearest lot line' <br /> in^� ---------- <br /> Type <br /> umber of lines �- . .'LongH, of each line---------- -,--.- Vl6th of hanc6--.-��" /' <br /> -_ <br /> 'rp" "' ""= material ~~r^+of — material---'----- - ' <br /> th <br /> - . ' <br /> Cesspool: Distance from �e�n,� w�L...- .__��tuoo:�rom�oundut/v°_ ' Lnmgmwnvno� . _ <br /> ] S�e: D�me+ec�----..L---_Depth_---..____--.__.�_.�ouid Cupo6+y._-_.__-gals.r � <br /> .^i <br /> ' <br /> Distance 6o restbuilding----------------------------------------- <br /> Cl <br /> pairing escrilL <br /> ' ^ . ` � / <br /> _--.—__-_-_---_.-.�_---.__..-�-.__�---_—._.____''---'__..__.-_-__---____._._-._--.. <br /> __________________________.__..____________________..__._________�_____--'_-.---�-'-''-'--' > <br /> have prepared this application and that the work will be done with Joaquin County <br /> ordinances, �+mfo |aws, and rules and regulations of the San Joaquin Local Health u/mv/cr.� ' <br /> ~7 | <br /> �� d& � /^�m� ^ }Ownwrwd/oConacor <br /> ` ;gne,-. -'. -.`�-^c..\���m��',---."---.^--.�----_-_-_______-__________` <br /> BY:______.___________________._________________.____.--(rifle)----------------------- <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 /> FINAL INSPECTION ' ~� Dote ��� .. -.-----_.—.- <br /> ' SAN |N HEALTH DISTRICT <br /> ,uoSouth American w�° o�w�wmq"�o"°� *�� 1u4Sycamore o�w, zw5w=,mho�°° <br /> ~~ ,*�� . <br />� <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EG , "E="w ^'o, ww "'o/ ATLAS <br />