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v � ��� �������� ����� Permit No. <br /> (Complete- - in Duplicate)— 31 <br /> Boho Issued -...�l........... <br /> Application is hereby made to the San <br /> This application is made in compliance with County 0 d 549. <br /> JOB ADDRESS AND LOCATI K.W./I ...7:w............................................... <br /> Installation will serve: Residence 2��Apm,tment House [] Commercial [] Trailer Court [] Motel [] Other C] <br /> Number ofliving units- 1-. Number ofbedrooms ..2L. Number ofbaths ----L. Lot size ----^ �«. ........ <br /> Water Supply: Public system21--community systema Private M Depth to Wute/ Ta6|wt.53--ft. <br /> Character of sail fp w depth of 3 feet: Sand [] Grovel Sandy Loam [] [|uy Loam [] Clay [] Adobe pmn 0 <br /> Previous Application K4mdm; (if yev'6ot,--------------------) No4-~ NmwConstruction: Yes [ff~-No [] FHA/VA. Yes 2��o 0 <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> � . <br /> Sept'; k: Distance from nearest we|i���-��.-Distance from foun6u+ion-�@�_---��Material_ .-.--- <br /> ~ No. ofoompurhnmn+�--..«�-----�izo-'_'���� �qu�6 6op��--°�'.x-_-..Capu <br /> D|,po,o| Field: Distance from nomnam well---_=n-Dist once frnm -_-/P .............. <br /> ��--- Number of ��� " <br /> Tvpo of filter mmto,luL-'--------------- --Depth of filter material--' -----Total length--.-. -_.-----_. <br /> Seepage : Distance to nearest wo|r------------Dis+unc� 6iv+anca to nearest lot line_ <br /> Number ofp�o._--I---Uning material <br /> u ~- Size. Diameter-_�3.........Depth----------2-i_-�......... <br /> Cesspool: Distance from nearest well .__--D��ncnfrom fnundu6nn--_-_-�n7og nmh,duL---__-_—' <br /> [] S�w: Diameter_- - ' Depth Liquid Capacity _-�ni� � <br /> -'----'' ' '----------���---' '---'--- <br /> Privy: Distance from nearest well'_'''' ---------------------------------Distance from nearest building.'''--'_-___--'-- Y <br /> [7l Distance to nearest lot line------------------------------------------------------------------------_---------------------------------------- '_----.--- <br /> RemnJnkng and/or repairing (describe):---------------------- -----------------------------------------------------------------------.'_-.'__.-__.__.-''_---- <br /> ...................------------------------------------------------------------------------------------------------------------------------------.....-----''------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------........'-------------------------------------------------------------------------------------------- <br /> ------------------------------------------__.---._--'''---.--.-_-___'-----__--_--_.__---_-_-__.._-._---_--_--. <br /> have prepared f ' ap ication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and reg io of the San Joaquin Local Health District. <br /> (Signed)-------------------------------------�p---------------------------------------------------------------_---------_(Owner and/or Contractor) <br /> 10 f "stem i re <br /> (Plot plan, showing size Of lot, locat! n f system in relation to wells, buildings, etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLYAlterations . <br /> REVIEWEDBY--------------------_---------1-------�?�-----------------------................... DATE------------------------------------------------------------ <br /> /or recom� fio~--�-- ------ -----' ''=�-' --'-'----- <br /> :ii-..�'owr,.. --'���~�`.*��x�~ ..^�^''��-"---___.____. <br /> '---'''-'--'''--''-'--''---''—'''-''''-'''-'''--'-'--''--'''---''---''-'---'''---''-'--'---'-- <br /> .---''----_-'-_-_--''_''-''-_-_'''-_'''---_-''-_-''-_'----'''-_'-_-.--'--''-_'------''-'^-' <br /> -'-'--''---'----'--''--''----'''—''--''-'-'--''-'-''---''--''—'''-''-''---'-''-'--'----' <br /> � ��^� - »� ^� <br /> HW/\L INSPECTION BY�-.-J'�. ---.—.. D���-.���--_.����--'��--�--------.—. <br /> SANJOAQU04LOCAL HEALTH DISTRICT <br /> 130 South American Street '300 West Oak Street 12*Sycamore Street zw»West 9th Street <br /> Stockton,California Lodi,California wa"to^*'m,nfornia Tracy,California <br /> ES mc"m= °°" w" °'". ^TL^" <br /> � <br /> � � <br />