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� <br />� <br /> APPLICATION FOR I���� PERMITPermit No. <br />� <br /> (Complete in Duplicate) Date |ovn6 <br />' �no|�at�n is hereby u6o to the Son Joaquin Local Health District for o permit to construct and install °- <br /> f�;~�rk herein described <br /> T�� <br /> application is made in compliance ' ''6o�' <br /> Owndr's Name__,&?__.1061� --- ---- ---------------------------------------- --------------------------------- Phone---------------------------- <br />/ Contractor, m .—_-----_—�-------------_--'--'_—'''—'-- ` <br />) Installation will serve: Reo|den'°"M /\parfmont House [] Commercial [:] Trailer Court [] k4ofe| E] Other [j ' <br /> Number ofliving units' Number of6v6r"or, .3--- Number ofbaths —\ — Lot size <br /> Wafer Supply: Public systemCommunity system -El Private to Water Table �. ff. <br /> Character of amU to m depth of J feet: Soo6 [] Gravel E] Sandy Lnum�l 'Clay-Loom El Clay 0 Adobe [] Hardpan 0 <br /> Previous Application Made: Yes E] No New Construction: YoNENo F-1 <br />` TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> Y <br />/ (Nn septic tank or cesspool permitted R pu6|;c. seww, is ava||m6|ewKhi° 200feGk) ' <br />' - <br /> � <br /> -Tank-.~ D�iv—fo�n.o'o-f—p—um-� neorest'~eU�'_o---�_.— <br /> -_— <br /> ity <br /> =No. of compn�munt,--.� -- ---Size- /e ». --Liquid 6upi —../j ---_/ Capuc ----------------------- <br /> D' <br /> _`___ <br /> —_ <br /> _ <br /> ordinances, State laws, and rules audg rg I fi of the San Joaquin Local Health District. <br /> a| Field: Distance from nearest well-30-0- Distance from fou 6 ti /-.5-^ Distance to nearest ]of |i� $^ <br /> Number of lines—.1�---- ��Type of filter material- �----.Dap+6 of filter mofori.aL- .^,---�otv| <br /> Soapuge Pit: Distance to noony� .uU'''--''-'-D�+°'nce from foun6*1|mz'''__.__Distancefo nearest lot ~_~ <br /> k <br /> � <br /> ~--—t <br /> ENumber ofyH�'_—__--Lining mata6uL_--_'_..S�u/ Diameter._--__-Depth—_—___--'- <br /> Ce�poo: Distance from noora� *�|_—'---Distance from foundation--------------------- �uL <br /> L1 Size: D�me+oc_—_—_._—_.__.Depth..___--._—._—°--_--.Uqu[6'Capmc��.. -__- —_—'gu|s <br /> Privy: Distance;'��m nearest voL''—_—'''—'''--__.-'—Distance from nearestbwUd�g_------_.—_—_.'_- <br /> Ll Distance to nearest lot line <br /> Remodeling un6/n, repairing c�b��—'_'_—.—'''—'�—__'_--___.---________.__..______._____ <br /> _--- __'__--_.''—__''—__-___--'____.-_—..___..___.._.___—_—_'-_-- ----_. <br /> ��`���'������''�����'������`������''���������''�������������`��'�������'�'� ������` <br /> hereby certify that I have prepared this application and that the work will be done in accordance with <br /> ----___.—'___''--__—__.'-__--__-''—___'__.'--___--_—__-__—.___.--_--_.`_..—_ '—'—�'| '''�."e�'__.'--''—_--'—_-'� —''—'—' <br /> ( mrpmn. m`vwmgmzomr �t �ce�nm �4 *ys�mm re�nnnfo *eUs 6uO6ing�"e+�� can 6w'p��ad on rovwme-�6oL <br /> DEPARTMENTFOR USE -N <br /> LY <br /> ------ <br /> REVIEWED BY — ------------ <br /> -- <br /> � —'- <br /> ' <br /> |\ <br /> / <br /> -'--__�----_ DATE ____- ---'--'8U|LD|NG PERMIT ISSUED_--_�~--''—_.''---''''—_.—__-'''--''--''''—' DATE.'-_- <br /> ---------- <br /> Alterations and/or recommendations:----------.-------_----------_---- <br /> _'_._—_—.__�__—._------__-----__---_-----._—___--__—.--,--__.___.___.._ _-.__ <br /> _—'—''__',_''''--'----''—_.''—�''----'''''—'''---_—__—''''—__-''—_''' <br /> ---____—.—__---_--._—_--_'_—'_-----_'--_-----�_-_---_— -__..__-- '--_- <br /> '--'-_—'---'--''''— ' ---��-'''''---''''_—''�—''''''---'''-_�-- -_.'—_ <br /> RN \L INSPECTION 8Y' " ._---_--_ Dut�. _' ---------- <br /> SAN JO; CU|N LOCAL HE/ LTH DISTRICT <br /> /ao South American e�m monw"� Oak s»�"v |ox Sycamore $, "+ ow North ^c^ stm° <br /> Stockton, California Lodi, California Manteca, California n*"v. oa|a","* { <br /> � <br />. <br /> ES-9-2M os| nv"�o6 vv�/oo <br /> l � � <br />