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^ <br /> p <br /> ��������� ��� �����T �� ������ Permit �� <br /> [ .�~ ^ ' - -- <br /> /' . <br /> | (Complete ��— Duplicate)— <br /> Date |mmaJ ---' <br /> ' plica+ion is 6e to the San Joaquin Local Health District for a permit'fo construct and install.the wo4 herein described. <br /> is application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND L(�CATIONJ:�ro P, <br /> ---- <br /> Owner's ."�.=` . <br /> Installation will serve: Residence Apartment House E] Commercial'K, Trailer Court [] Motel Other E] <br /> Water Supply: Public system)k�r_ Community system E] Private E] 'Depth to Water Table -------- ft. <br />� Character of sox to m depth o o feet: Sano <br /> ^ � <br /> � El <br /> Clay m,qo< Hardpan U <br /> Prwvioum ' rr~~~^— Made: Yes \ No New Construction.' Ye, E] No [] <br /> TYPE Of INSTALLATIOWAND SPECIFICATIONS: <br /> � (No septic tank o, ` °rmn�te6 if public smxn, is available within 200 feet.)� Y <br /> Septic Tank: Distance from nearest well------------------Distance from foundation--------------------Material -_---._-_--____ <br /> [� No. ofcompurtr6nfs---- ---------------------Size--------------------------------Liquid 6ep!h--------------------------Capacity----------------------- <br /> Disposal <br /> -''_--'''D|spos | Field: Distance from nearest wcU-''--'Distancn from foundation-'-''----Distuncn to nearest lot line'--_.'- <br />� El Number of lines-------------- -----------------Length of each line------------------------------Width of frenck--__-_----. <br /> Typv of filter material-------------------------Depth of filter material------------------ ----Total length----------------------------------------- �' <br /> 1 6 <br />' /� Seepage Pit: Distance to nearest » -~ ~- . D�+ �to � k'no'.. <br /> V - <br /> X ---Number of pits.-[---4----Uning ^ a+e ' '�'�-1.Size' Dium�e' � Do�6 '' - ---' <br /> : <br /> Di stance from n�ore=t-wu|L--- ---Distance from foundation....................Lining motoriwL-------__- , <br /> . [] Size: Diameter--- ---------------------------:-----Depth ''-'-----------------------------------------Liquid ------------------------_--gals. r~~ <br /> T �~ <br /> Privy Dst nby from myanvsf well —-----------------------------------------Distance from nearesf building---'--'__________ ~~' <br /> F] Distance tonoa,'est lot line------------------------------ -------__-'�_--__------_.--.�---_-----� ~' <br /> t . <br /> Remodeling and/or rppairing jclpsch �z��-+'-�= ----------- <br /> --------- <br /> --'' ~ <br /> ----'--~-----------'----T-'--`--""--'------~~-'----',y---'--"''~---'-----------'-~---'-' <br /> ---'-------'-----'------'--'---'---------'------------------------''-------'-- <br /> '--'--.----'__''-''-'''-!'-_____''--..-_.--------_.--'---'-_.'''_-�_--'''-'__''---'-----''-'hereby certify that hp,epm,n6 +�m apo|!nmt|nn and that the workwill be doneiaccm�6anumw�h San Joaquin <br /> Com�y �L <br /> ordinances, $hufe laws, and rules and regulations of the San Joaquin Local Health District. <br /> -� .��� � ^�| <br /> �� 4�5��`..��-.�9�--��)�w� .1�J��~.~-------------- --------------------------------------------------------------- --------(Owner and/or Contractor, ` <br /> By:-------------------------------------------------------------------------------------------------------------------------------------7itf le)-----._------------- -------------------------- <br /> /� ��, � � � �� of system in relation � w� buildings, etc., can be placed on reverse side). <br /> ' / <br /> FOR DEPARTMENT USE ONLY <br /> ---------------------------------- <br /> ----------- <br /> Alterationsmn6/ur recommend afioms.:------ -------.---- <br /> �- -----_-_-_-.___--_-.--. ------------------- � <br /> ------------------------------------------------------------ ---------- -------------------------------------------------__________�____________'_____ ___'_ <br /> -'---''—''------_'---''_-.''--'''---_''--'''---'---'''-''''---'--''-'_-.-'''-'--� - -_''-_.- <br /> I <br /> ---'--'''''''-'-----'''----l'--''''-'''--'''---'-'----'''-'''--''--''-'--'--'''-'-'--'----'''' <br /> ------------------------------------------------------- - ---------------- ------------------- --- -------- --------------------------------------------------------- ----------------------------------------------------- <br /> l <br /> |�l — �� ) ~ <br /> RN/\L INSPECTION BY-_-� ----..�-----.—.. Dut�--`--._-.-..����.-----._---._- / <br /> ' SAN JOAQU|N LOCAL HEALTH DISTRICT ' <br /> /30 Wwm Am*ri"a" strmav ommWest Oak Street Aox Sycamore Street $14 North ^C^ Street <br /> ������v ��)Kv�/m f Lmd} �m|Hwmru �dunn"uo. �w|ifwmim Tracy,~ . � . . <br /> ,IG-r-21A 14"°^.^. "" .°~ <br />� ' <br />