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APPLICATION FOR SANI <br /> (Complete in Duplica ) FXpj'R7-S ONE YE e Issued --- <br /> nom DATE <br /> Application is hereby made to the San Joaquin Local Health Dist rict for a C:'CEonsTr nd install the work herein described. <br /> This application is made in compliance with County Ord�? ce No. 549. <br /> ' ' -----� ' <br /> Contractor's N ' ^ <br /> on omo----.----��.«�.���s=�_.���-.,��---./. --_-----_-�_--.-----. Phone---__—_-_ <br /> Installation will serve: Romidvne =f Apartment Hou ' [-] Commercial [] Trailer Court [] Motel E] Other [� <br /> Nu �e, oF |�p|ng uni+s� .. Num6o, of6u6"nom, ��- ~w <br /> m -�- m6e, of6nfh,ZZ- Lot size � 1�*..��. ��.~�.»1----------------------- <br /> Wafer <br /> . -----'Wa+wr Supply: Public system E] Community system El P6vute s;r Depth to VVo+er Tu6io 30' <br /> Character of ,n|| to a 6apf6 *{3 feet: Sand E] Gravel E] �on6y Loam Er'-Clay Loam E] Clay [] Adobe [] Hardpan [] <br /> Previous Application Made: Yes [] N New Consfruc+inn: Ye, E] FHA/VA. Yes E NuZ� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � <br /> (No septic tank orcesspool permitted if public sewer isavailable within 200 feet.) <br /> �� <br /> 5 L~c��.^�Tank: Distance from nou,u,+ �o| -'D � /DMaterial- <br /> No. of comportmpt,- ----- _.. <br /> D���| Field: Distance �m ~eU '� -- � ' <br /> Number of |�e` _��� .- .-.----Length of each |; <br /> - Type of filter mo+e�aL..����L.��''Depth <br /> of <br /> �Ife, mo+ehuL/__37.A0--..7o+o| length- <br /> 3uupugo Pit: Distance to neanodweU-'-----Distance from foundation._--- .-.Distancefo nearest lot line ---.—.. ' <br />/ [l Number ofpits------ ---------------Lining material----------------------- Diameter-----------------------Depth--------- --------------------- <br /> Cesspool: <br /> -'-'''-'-Cesspoo : Distance from nearest well ''---'''Distance from foundation-------------------Lining mmtnhvL-''-'-�_-'----- <br /> F] Size: CSomrfoc-----'_..--'��Deoth-''''--''''--_-��---''—Uoui6 Capacity-- -------------------------gals. <br /> Privy Didonc* fn,m nearest well '''--'''''-''- --------------Distance fn,m nearest bwU6�ng.'-'''-���'__'-'-- <br /> 0 Disfancu to noa,n, ]of line------------------- < <br /> Remodeling and./o, repairing fcles r�be):-'-- --''���''---_-'----_.'--__.--____________________._________�__ <br /> �__.__.--_--_-._-_-____--.__-__----__----.-_-__._-----_-._--___-.__._.—._--- <br /> -----''--'--''-----''-'--'''-------''----'--'--------''-------''--'--'''--'--''-''--''--''- <br /> '---------------''--'''------------'---------�--''------------'------'------'' <br /> I accordance with San Joaquin County <br /> ordinances, State laws, d�Wes ulations of the San JosIquin Local Health District. <br /> p/gnom/---�-/--------------- --- ..- -----'---- -------------_----------(Owner and/or Contractor) <br /> By:----------------------------- ---------------------------------------------------------(T;flw)-------------------------------------------------------------- <br /> (Plot plan, <br /> ____---__(qntmlan, showing size of lot location of system in relation to ~o|ls. 6ui|6hmgs' etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ---------------------------- ----- DATE---M_ <br /> DATE <br /> -------------- <br /> 14 <br /> -------------------. -----------------------.. _-------_--_-----.. <br /> RN/\L INSPECTION BY:--------- ��~-� �o�� ux\��ywm° <br /> -��' -------''--- '—z'''�-''''-'''-'--'---'--''---- <br /> SAN JOAQ0N LOCAL HEALTH DISTRICT ' <br /> /sm South American Street sooWest Oak Street /32 Sycamore Street ow North "C" Street <br /> smcm"^. o°/no,»/o Lodi, California Manteca, California Tracy, California <br /> u--,�-zw . v*./mu 1'57 r,pzo. � <br />