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'--- - -° ' <br /> /= <br />-4w <br /> ' <br /> ° <br /> l APPLICATION FORS�N����� ������ �m� N� � <br /> ~ <br /> ` -`-- in --'---^ Date Issued -------/7. . <br /> Application <br /> - �--' '_-- _ -~ ~~. <br /> ���-_- _ � <br /> application <br /> JOB ADDRESS AND LOCATION__%J;�vM -A0_a4J ep— --------- ------------- <br /> It <br /> ----A6zA..... <br /> �- a / <br /> ` <br /> Ownermu ~.��~�*�� -_-__---_---------._.. Phone <br /> '-__.__-'.--' <br /> ?.5::q....����� <br /> Cont�c�oro Numm-.. -������-_- ......------------------------------------------------ ..................... Phone.................................. <br /> Installation will serve: Residence e Apartment House E] Commercial [:] Trailer Court 0 Motel 0 Other [3 ' <br /> Number *fliving units: -.I. Number ofbedrooms 3. Nvm6n, of baths -I Lot size ' _--_-_-.-- <br /> Water Supply: Public system 9��CommunHy system Ej Private [] Depth TO Water Table 4_0 ft. ' <br /> Character of omi( to w depth of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam [] Clay [] Adobe nJpan [] <br /> Previous App|iumfimn Made. (If yes,date--------------------) No U,~~-Ne* Construction: Ya, r?'INm [] FHA/VA. Yes 0 No11 -» <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: {} <br /> /No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) <br /> Se k� Distance from nearest wmU-�r�=_'Distunce from foundation-..����--Material - v�������,--.-_. � <br /> n�°~ No. ofcompartments-----�2 ---------------Size--'3. -----Liquid6aA!h_-/4------- --------�Capu KO a �l <br /> Disposal Field; Distance fn,mneareU^---- Distance from foundat�n �' <br /> � .,-_-D��oce to nearest �t |�a'97,-- - <br /> Up( Number ^" ' <br /> Tvoo of filter mofnria|. /?m_C,_'t-------Depth of filter material .����..........Total length'- ........................ <br /> Seepag Pit: Distance to <br /> m»� .~..~ �...U ~.~.. ^~~ v--.-Distance � .~..`~. <br /> Number ofp�o-z��--.-LiningDiameter-14!_7 <br /> mute�u|,�K�u.�--.�S�e� D�me+e' ��y.~----Dopf�' ----------------- <br /> Cesspool: <br /> -_- | ` <br /> : Distance from nearest well----------------- from foundation--------------------Lining moharioi''-'-'''-'---_- |, <br /> [� <br /> Size: Diameter-------------------------------------- ------------------------------------ ---------------Liquid Capacity----------------------------gals. ' <br /> Un , <br /> Privy: Distance from nearest well --------------------------------------------Distance from nearest building-_'---'--'__.---- <br /> [] Distance to nearest lot line---'---.--._---_--__'____..----___.-__-_-__--_-.. <br /> Ramo6eingumJ/o, repairing (demribo):-------- ----------------------- ------------------------------------------------------------------------------------------------------------- --- <br /> ---------'------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- --------------- <br /> ----------------------------------------------------------------- --.-_-_-_.__-..................................--------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- �����­­------­---------------- <br /> I hereby certify 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 re laflon of the an Joaquin Local Health District. <br /> (Plot plan. showing size of lot, lo in rel fion to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY '45 <br /> Alterations and/or <br /> --'' �x <br /> � - �� �� -- /��� ^- / �'�� ' ' <br /> °- '`~"^~--^�`�~'--''�~"^^^' � ��- r^ {� �� <br /> ---_----------_----_-------�---_----'__'-._---_.~.__._-''-_----_._.-_- / <br /> '--'__'--'''-_'-----_''-'----'''--'--'--'------'''-''--'''-''_''-''-''--''-''--''-''_--' <br /> '-''---'-''----_''-''--' ---------------------------------- '''--------- ''--'-''-'''_--------- -------- '-''---' <br /> ' <br /> t. �� ` <br /> FINAL INSPECTION BY:-------- Date --'��..���xm-..'V---'��..���-------- ------------ <br /> . <br /> � SAOW JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 ncv/nco e'59 cm n'uc ^rL^s <br />