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FOROFFICE <br /> Application is hereby made to the San Joaquin Local Health D.i-strict for a permit to construct and insi-all the work herein descriled. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ----------------------------------------------- <br /> �Phone- ----'---'-- <br /> Installation will serve: Rox|dunoo B' Apartment House [] Cnmn ,n6o| [-] Trailer Court [] Motel [] <br /> Other <br /> Number ofliving vnUn' _J_ Number of bedrooms Z_ Number of baths Lot he ----- <br /> u � <br /> --����( /� � -.__. <br /> Wafer Supply: Public system a Community system E] Private [:] Depth To Water Table � ft. ---- <br /> Character of soil to m 6mo+6 of 3 fe,�+: 3un6 [] Gravel [] Sandy Loom [] Clay Loam [] Clay [I Adobe E3 ' 'iIrdpa.- <br /> Previous Application Made. (If yes,date------- --- -------- �" <br /> ) No "~ NmvConxtruo+ion., rm <br /> Ya� [] No FHA/VA: -1 �J- <br /> `� <br /> TYPE OF INSTALLATION AND SPi /R(�AJ|�]NS: -- ^~ ^~ <br /> (No septic tank or cesspool permitted ifpublic sewer is mvmi|m6|e within 200 feet.) <br /> ^ <br /> SeptDistance from nearest well -- ---------Distance from <br /> ' of <br /> | ''--''-- foundation----_------------Material <br /> �on ---- -----LJ No. ofcp�pu,h '-S�� ' -''-�''~-�ouid clep�»------------------ -------Capacity---._____-_. <br /> uo � <br /> |\ <br /> Distance from <br /> nearest <br /> -t-weL. �- ` -----------� ' <br /> Number of lines-'--/ - - D|�ance +o*�nnoca6,e�o^���tline.--7 <br /> —--- <br /> ' <br /> Length of |ina-� q-' .--'''_ Yi6H` of <br /> Type of GKor motorial..3-!--!�---------Depth of filter mo+erial-/V�. ............ length------- <br /> ^^~~--'��----' <br /> - -- <br /> --'�oepu Rf� Distance to nearest �u| U��'�� - -~ tn '~~'~^' -------------- <br /> Number of pilts -'L Lining �*mnm �u �� �Size: Diameter--- _ -----Dept h...... ------------------------- <br /> Cesspool: <br /> D�+mnxo from nou,e` ~o/L-_-_-Distance from foundation Lining mo+�ru------ <br /> [] S�o' Diameter-_-' Doo� ----- ' -------- ' <br /> . _____________ . ___________ Liquid' ; -'----'—'' Capacity----------------------------gals. <br /> Privy: Distance from nearest well _------------------------------------- ....Distance from <br /> � - <br /> -.---n-'* <br /> --o-r-_o-,--'-� 6----u_-�building_.building-�g-� <br /> ------------------------------------------ <br /> 0 <br /> '--- <br /> -- <br /> '-.-- <br /> ---- <br /> -' '--'_--------------------- <br /> Remodeling <br /> -- <br /> _-'_J Distance to neo,�� lot |ina`-_._ - <br /> _..___.___.. ____ _ . <br /> Kemo6n�gon6/o, repu�ngkJom�b��'_---''_-''-_-''--_.---_-''_-.- <br /> -'-_ --_-_._._-__---_.___-.-____..__---___-----_---_''_-'-'''---,--' ''-------------- <br /> Alterations <br /> --_' <br /> _''-'--'--'_--''-____-'-.----__-.__.---_--.__-'-___--'_-___-_.--__-..'�_ --_'- .-. <br /> . <br /> -'---''--'-'--'--''--''--'--''-''--''--'---'----- <br /> � <br /> -----'---'--''-'----------------- <br /> ; --, --.../ .~. . have p -'- ' ---' ~^6 ��mtt6� work will be done in mccmnd*"ue �H� San Joaquin Cou�yordinances, State laws, and rules and regulations � moSan �aqw� LocalHea�h ��6u� <br /> '0ianm61'--______.____.'' '' -'---'------'--- <br /> �n----_-____-._ ` (Owner and/or ' <br /> __ _._____________.____ ' '--'-'^'^~'--''------------- --.Uqmf �an. �~ w�ewf �t �caf�� mfsy�em /nrm��*nfmw�� �ummgs etc., can 6e 9�cedwnrmver� *�� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED � -----.-_.' - --''-- oA|E-REVIEWED�ED 0 ---__._.___-_-+-----._----.--_'''--'' ~' '8U|0U|NEPERMIT ISSUED. ` ._/ -'- <br /> A�ermt�"umod/orrecomnonda�wnw: ___ --' DATE- <br /> ---------- ----- - <br /> ------'-----'-----___--______._____.__ ___.__ <br /> _'-------'''-''---'--''-_''--'-''''-''-----_---__''_-'--'''''-'--_--'---__--_'__.___._._. <br /> ---------------------------------'-------------' <br /> " vnL INSPECTION u ---_'-''--_ '- <br /> |N°Aw HEALTH DISTRICT <br /> /3m�,�xm°a"= x�°� x0oW°mOak . /2wSyxa"o�wme, <br /> Stockton,California Lodi,California.- Manteca,California o0swwm9s�" , <br /> cn 9 REVISED o'op zm s'ae xrLxm Tracy,California ' <br /> ' x <br />