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FOR OFFICE USE: <br /> Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> OC TION --------'^--~ <br /> JOB ADDRESS AND <br /> Installafion will serve: Residencefg�-�Apartment House El Commercial 0 Trailer Court 0 Motel 0 Other [3 <br /> Number of living units: I... Number of bedrooms Number of baths ___ <br /> Water Supply: Public system Er"'Community system 0 Private (] Depth -ro Water Table <br /> Character of soil to a depth of 3 fee+: Sand F] Gravel [I Sandy Loam [3 Clay Loam [3 Clay 0 Adobe M.�-Ilardoan C1 <br /> Previous Application Made: [If yes,dote_------- --------) No P,-IN_ew Constru-ction- Yes E] No J:J�HA/VA: Yes [:] No Z��_ <br /> TYPE OPINSTALLATION AND SPECIFICATIONS: <br /> (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank-' Distance from nearest well .Distance from foundation ' � <br /> Mu+o,imL----------- <br /> ----- <br /> ^� `N-u ofcomp-mrtne"h--.'---'_S�n-_'-'_--''.----Liquid o�pmCo <br /> pudt ----------------------- <br /> -------_----------- <br /> _'___--. <br /> . .-D�tonce to nearest �tUm� -_-__ <br /> --_------------ <br /> Disposal ' =~' Distance from nearest weL----..[x,t�cn from foundation <br /> oftn*"ch----------------------------------- <br /> El <br /> '-_--__ <br /> E] Number -� |�*o' . Length ofeach line. - <br /> Type uffilter ma+o,iaL.---------------------Depth of filter material -----Total Tota| lengt. . . -'--_-__._ <br /> �,�u�n-/-q to 47/ <br /> ~~~'~ D�um� to �& -D��m� �om f - �5 ' � � -__'---- <br /> �Depth- <br /> Number <br /> of pif,--+-----Lining mmte�mL� O��]� ��nD�meR.�K`�� <br /> \ <br /> -- Distance from nearest well from foun6u6om-----._Lin�g material----------------Cesspool: - Depth Liquid '_---_---�mm. <br /> ��e� D;ume+o, ----__-----� . ------.--------'''-, Capacity <br /> -- Distance from nearest well'--_----._-- D� ''-_--'--- <br /> --- <br /> ---� tmnce fn�m namreo. ���Gng <br /> ] Distance to nauny� |o+ line . . - -----------------------------------------------------------_--.--'� <br /> Romodeling <br /> " <br /> and/or repairing (6oacribe):---------------------------------- ----------------------------------------------------------------------------- --------------------------------- <br /> --_ <br /> -__..---__'-''--_----.-__-.__.-____''--'''-''--'-__-''----_''---'-''--'--''----'-'--.--'--- <br /> ------------------------------------ -_--_._ --------------........... ------------------------------- ------------ ------------------------------------------------------------------------------------------ <br /> � ---__-.-' -_''-_-__._-'-'---'-''-'' <br /> '--------'-----'--------'-'-- n6 that the wm, �3 6m 6 �n mccor6mnc* w�h San Joa qu� Cmun+y <br /> ordinance$, Sf, la,-, and r of the San Joaquin Local Health District. <br /> (Owner and/or Contradorl <br /> (Signed.............\ --------- -- -----_kz-------------- - ---------------------------- <br /> By:----------------------------------- ------- --- - ---------------------Ir Pon <br /> _t ion of system in relation to willias, ings, etc., can be place on reverse side). <br /> (Plot plan, showing size of lot Oc <br /> FOR DEPARTMENT USE ONLY <br /> APPL|CAT|{}N ACCEPTED DY..-^�� '*�n-*r�^-�_..=�=-~.'__.-__-_--_- _ .T__.--�����- <br /> � REV|EVYB} BY --------------- "``.`-'---'''-'--'__-''____.- <br /> '-----'--' �&� D/N�_ ----'-----' <br /> BU|LD|NE� PERW[T |3�UED '---'--'__.'--'-_'''-''--'--'-__'''---'--- -_'_-.'''-' <br /> -' .-__-..�--'_.-----',---'---_---_�---- - .__ � �---__ t-11 -''-.`^--'---------- <br /> ----­---------------- <br /> --'''-'--'-_'-- --'-'-'-'''---'''''--'''--.-'-.-''-'- <br /> Du�� ~�� -- �� ��-'��'--� -''--'-'-- <br /> FlN�L INSPECTION 0Y�-'�'/' '-�'----'--- <br /> SAN JOAQU\N LOCAL HEALTH DISTRICT <br /> 1awSouth American Street o0wWest Oak Street 1o4Sycamore Street 20sWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 ocwsco u.oy zw s'aa ^rL^m <br />