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J <br /> � A�� FOR SANPERMIT <br /> ��� N� <br /> � ,^ m ' X (Complete in Duplicate) <br /> V/ Dofo |osued ..!1/ �/^��� <br /> � <br /> Applicationiis h reby made to the San Joaquin Local Health Dist rict for a permit to construct and <br /> ` install the workherein described. <br /> This application is made in compliance with County Ordinance N 649. <br /> v............ ---------­---------------- --- --------- <br /> JOB ADDRESSAI�LD�OCATION--- y <br /> Phone.- ������' <br /> Contractor'sNumo-. --�.�or�=v-o=�=°°.,----._--.. '�.-.-- <br /> Installation will serve: Residence �� House � Commercial � T�|� C�� [] Motel 0 ��r � <br /> _ � | ���� <br /> Number of |i�ng units: -�-- Number ofbedrooms �� Number of baths .I---- Loto�e -J��_~_ - -'----.. <br /> Water Supply: Public systemnKY system El Private 1-1 Depth toWa�rT�e -1--s-ft. <br /> � � of'soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam F1 Clay Loam E3 Clay [I Adobe 21�-�rdpan E] <br /> Previous Application Made: Yes [l No &'^ e° Construction: Yes 0 No ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: p~� <br /> |N* septic tank or cesspool permitted if pu6|icsewer � avmUa6|ewithin 200 feet.) <br /> ``'''^ '-nDistance from na�,e�+ well----------------- from foundation--------------------MatorioL--------- <br /> ------'- <br /> No. of compartments--------..Size. . Liqui6 dmp+h ��� .�Cupuc/ty--------- <br /> 'e4-w� <br /> "Disposal Rv|d' well Distance from nearest -'''---Distance from foundation--------------------Distance to noun,`t lot line----------------- <br /> r <br /> --.-- <br /> - <br /> [ <br /> Num6arnDne�.'''--'�'---''Length � oo� |�no �J��o� te�h <br /> o '''-''-'-'--'-'-�.Type f �H�r material -''�--r <br /> ( <br /> r� �c) _ +o nearest n <br /> o <br /> ---- <br /> Seepage Pit' D�stanca to noo,e� � Distance from foundation ^J'- <br /> ize' Diameter- -2 --_Depth -� �------ <br /> — ' Num6or of pits---------t---Lining material =~ = <br /> C`~ rool D;sfance from nearest well-----------------Distance from foundation'-���''_Lining moforoL'�''-''-''-'_-'- <br /> Size: Diameter--------------------------------------Depfh_''''''''''----''---Uou|d Capacity----------------------------gals. <br /> — <br /> Privy: Distance from nearest well----------- -------------------------------------ui,tunnr fmm no"resf6uikding � . . <br /> EDistance to nearest lot '-''-'''--'.-''-'-�'' <br /> Remodv|ing <br /> �~ <br /> and/or repairing �axch6e\�--------'-------_-___.---..__.----_-_----__._-_'_--___.. / <br /> �����'�`�``�`������`�``��`�``�``����� <br /> __.-_--__---.---.-_----___--__.--____.--'--_-.- . <br /> '-''--~----'-''-'''---'---~-�----'------- ----------------------------------------------------------- --------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------- --_----__---__--_--._-__..____---_-----. <br /> ' hereby --ti` that have ' � n6 +�u� t�ewu, will be 6wno in accordance with Sun Joaquin County <br /> ordinances, orw,e laws, and m�� =d ,mgula^-- oftho San Joaquin Local Health District <br /> (Signed,--- / <br /> ------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> � . | <br />. � <br /> RB/|EVVBD BY-------------------------------- ----'--- --------------- ",`.^_ / <br /> 4� ' / <br /> | <br /> BUILDING PERMIT ISSUED--------------------------------------------------- D/��__ .___________.____ <br /> ' <br /> Alterations mn6/w, recommendations _-__-________________________--____._______._________.. , <br /> _''''''''-_-'''-''''-'''--'--'''--'—'''------''''----''----'''---''-----''--''--''-�- 1 <br /> __------___________________________________________________''''--'-'_--''--''''''---'--'--'--'- | <br /> ----------------------------------------------------- ------------- ---------------------------------------------------------------------------------------- ------------------------------------ ------------------------ <br /> --------------------------------------- ----'' --- --_-''_--''' ''''''----'-'-''-''_-- <br /> v <br /> Dufo �/ / � � ______ <br /> �N/�L INSPECTION BY�._-.-�---._�'..�.�—./c-�'�.�.--. ---'� .~�''-------''-'-�. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /vo s".tk American Sfre°* uoo vv°* Oak Street |uc sv"°*"= Street ow North ^C^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />