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H <br /> t/ ����ON FOR �NQ��� PERMIT <br /> '-�-- <br /> "l- 3() _�? ~ -- (Complete/ inDu� �u� <br /> b- <br /> ^ <br /> n6 in�uUthe work herein described. <br /> Application '^ ^ by made the San Joaquin Local HealthDistrict for o permit to construct o <br /> This ap. l�ut�nis, <br /> made incompliancewitkCou"tyOn]inunco No. 549. <br /> ~�� --___-_-______--'--------.-. <br /> JOB ADDRESS <br /> AND LO __---��� <br /> CharacterInstallation will serve: Residence M Apartment Hou.se E] Commercial F] Trailer Court 0 Motel [] Other 0 <br /> Water Supply: Public system 171 Community system [] Private W Depth to Water Table -------- ft. <br /> Sand E] Gravel El Sandy Loam[] Clay Loam [I .Clay M Adobe 0 Hardpan E] <br /> - - ' <br /> Previous Application Ka6o Yes [] No J New Construction: Yes [] No [ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public/sewer is available within 200 feet.) <br /> Septic Distance from nearest well-----5&2'�-Distance from found <br /> Disposal Field: Distance from nearest well )-----------Distance to neares o �n <br /> Distance from foundation--- <br /> ^ Length`"" "= of lines - <br /> Type of filter muto�o| ' --uopnf �\tormoforio| / <br /> ��L-------'_- <br /> — , �_- 7utu| \engt� <br /> --- <br /> ��. <br /> �y <br /> SaePoga Pit: Di�onco to nouna� well ___'-Qidnnxo fn,m foundation ' Didnncato nearest lot knn'--_----' <br /> LJ Num6arofo�o- ' ' Uning motar� S�o' Dio^ oter' �Depth- <br /> C*, 000. Didnnco 6nm "ouro� weL--_--._Di�uncafrom founJo�on-----'-_L�ing muto,� <br /> F3�e: Diameter-------------------------------------- - Liquid Copocity-----------gals' <br /> Distance 6nnn non,eo building------------------------------------------ <br /> Distance <br /> ____'---_.� ~^ <br /> Privy: Distance from nevro� ~oU__�--_--.----_-_----- _ . ______�___________ <br /> D�toncetonvo,as lot line <br /> � <br /> repairingRemodeling)and/or � <br /> lka--y......... ----- <br /> ---------I--hereb.y--certi-fy that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot pl;ayn. sho�ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPA--MENT USE ONLY <br /> :j�ACCEPTED BY r, <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------- <br /> --------------------------------- ------------------------ ----- -----------------------------------------------------------------------------/-----------------------1----------------------- <br /> SANJOAQU|NLOCAL HEALTH DISTRICT <br /> on South American Street 300 West Oak Street /32 sycamore Street nw North "C' Street <br /> W^n�" California Tracy, California <br /> Stockton, California Lodi, California °. <br /> ss-9-2w u's/ n°.i,oJ vv'2/00 � <br />