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FOROFFICE,/SE:Application is hereby made to th; � <br /> San Joaquin Local Health District for u permit to construct and install the work herein described. | <br /> This application is din compliancewith County {}nJ| N . <br /> JOB ADDRESS T1 <br /> Z-T - ----------------------- <br /> Contractor's Name--------­:------------'' ----- ............. .............................................. ''^~e`°~'~ <br /> Installation will serve: Residence ff�_�Aurtmo4_ House [] Commercial E] Trailer Court [] Motel [I Other El <br /> Number of living units: .-/-- Nv�6er of bedrooms - Number of baths --/ Lot size --�5-��.' ��-./...--.^' <br /> 'system system 0 Private [] Depth tnWater Table <br /> Character ofsail tomdepth of 3 feet: Sand [3 Gravel [] Sandy Loam [3 Clay Loam E] [ layAdobe rdpanFl ' <br /> Previous Application Made: Ufyes,date----------------—.J No [] � New Construction. Yes [] No A/VA. Yes [] No � <br /> TYPE <br /> septic +ank or cesspool perriffed if public sewer'is available within 200 feet.) <br /> .10 <br /> os Fie Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................ <br /> Pit: Distance to nearest 11 2Z0X6-"'_.Distancqfrzny fo4ndation___'5�?_-__'_ iistancAto nearest lot line.... <br /> Seepag ------------------ _3 �A <br /> Distance from nearest well------------------------------------------------- from nommet building----------------------------------------- <br /> [] Distance tonearest lot line'''---'--.'—_—_____.._______..____.____._____._____ ' <br /> Remo6oingo"6/o, repairing (dmscribe)------------------------------------------------- ............................................................................................... <br /> _ <br /> ^ <br /> ----------------------------------------------------------------------------------------------------------- --------------------------------------------------- ---------------------------------------------------------- <br /> -------------------------------------'-----''---'-----'----''--------''--'--'—_''__-------_------ ------------- <br /> ------------------------------- <br /> ..---- | <br /> ----__—.__.______._______._____.___________.____._____________.___._,_______________ .| <br /> I hereby certil;,af I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> °,dina"==v 4. � <br /> 41 <br /> e!54 By: � <br /> | <br /> | <br /> FOR DEPARTMENT USE ONLY ' <br /> '-------------'------------'--'----'------'---_'---.—._.' '—\�''�'''________ <br /> ~ ~ ^ ' ' <br /> —'—''--''--'''-----''--'--'--''--'---'--'''—'''---''--''—''--'----''—''--'--'--'''''--' <br /> HNAL INSPECTION BY:..�/ � Date ---—� -----------� --- ----- <br /> AN <br /> — <br /> �� J ���O]N ����LH��LTHD|STRUCT <br /> . / <br /> ' vuwSouth American Street uvpWest Oak Street 1o*Sycamore Street uv5West 9th Street <br /> Stockton,California <br /> 1 <br /> Lodi,California m""��.c"/n**/p Tracy,California <br /> "0 * REVISED "-5° nw °'°, ATLAS <br />~ <br />