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+~ � -j���7 ' \ <br />APPLICATION �R�N��ONpE/�� <br />\Connp|ofe in Duplicate)Application <br />is herebymu m,�u to �a !�n Joaquin L�o| Health District for u pcnn�foc��mcf and install �ewn� herein ����� <br />^ , .rr.~..".. ., ": m compliance wim County Ordinance No5497.� ' <br />JOB ADDRESS AND LO(�AT|ON <br />� -----.-���&���&���-~______. <br />| (]wnn,'o Name ---..'L-2 e_�__.,_� - ----'---------�9i* "?---- � <br />� ------------------'�''-� Phone ��� _��� <br />' <br />Address '�m , �_________ __��_ '-�_.- . <br />--__._--=__��-�--'��-_-._---�------'_--.__.___-'' -___-. <br />Conhnctor� Nvmo--_�_.��.__-__-__. ----'----'---- <br />. -__'-_'''---''�`''--��''''-'''''- Phone <br />� <br />Installation will serve: Residence [� Apartment Hcm,o 1 Commercial E] T�i�r Cpu�--'k4of | ��-----'Fl---'—' <br />Number of|��g units: T] Numb�of6e6 �� Number - ' ^� - Other-- 'Waf er Supply: Public System El Community system E] PrivateCharacter of soil to a depth of 3 feet: Sand [I Gravel [] Sandy Loam Ej Clay LoamClay El Adobe F1 Hardpan EjTYPE OF INSTALLATION AND SPECIFICATIONS:(No septic tank or cesspool permitted if public sewer isavailable within 200 feet.)Sepfic Tank. Distance from nearest weI_ 'Distance from foundation --- i�--------------- <br />..... Capacify ----- : - -------------- -- Size ---------------------- 4Liquid depth --------------- ---------- <br />------------- <br />D Distance to nearest lot, lin eeepage Pit: Distance to nearest well --- ------------------ Distance from foundation ------- r_ ----------- Distance to nearest lof line�_Diisposal Field: Distance from nearest well 5"' -.'4 V 'I f 0, JP - �----------- ^--"D;stance from foundation --- '__'_!_Distance to nearest lot lineType of filter maferial-2-1--e-2,2 _Depth of filter material -------- I _P!_1 --,--Remodeling an-d/or repairing (describe): ---------------- <br />'u Trl;T Tne worKHWIIJ in accordance with San Joaquin Countyn Joa un Local ea Ith District.(Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application).FOR DEPARTMENT USE ONLY <br />�'--_--____--_- <br />� <br />��'----'---� <br />� <br />-' BU|LO�N(�PERW|T/SSU�D--------------------------------------------------------------- <br />-�-----'-------------'------- ua/�--^(^��'����^����_________ <br />___ ---____._________ un/� <br />AKor H000and/mrrwuommen6uf�nv:-_-__''---'''----'---'---------'-' ''-------'-�----'---'-- <br />------------------------------------------------ --_-_---.__--__----�---_''-''_-_.'____.--'-_.---� <br />--'� <br />'--'''__'_-_'-''--�''__.''-''----''--_�.''''-_--''''-''-_-- <br />PERM|T . --'-' |3SUECi'' <br />''---'----'- <br />- - �---__-----__--''-__--'''-----. <br />--�` � <br />�~}�'��'''�]n+e) �N�L |NSPBCTC)N <br />.. <br />-�-'' <br />� <br />Date -----[�'�'�'��''�''`�- <br />�----'------' <br />. SAJN JOo4�'U/NL�'CALHEALTH DISTRICT <br />� /30South 4mn�uunStreet <br />�s-���w �on ��/am <br />- <br />Stockton, California - <br />' <br />