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. I} <br /> . APPLICATION����T� N FOR SANITATION N PERMIT 2;2, <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Heu|H` District for a permit to construct and [ndn|| the work herein described. <br /> This || fi is madein compliancewith County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION (o l <br /> nooneso <br /> Installation will serve: Resid enceE[ Apartment House E] Commercial E] Trailer Court' E] Motel E] Other E] <br /> Number of living uni�s- -i� Number of bedrooms Z Number of baths [A Lot size- -------------------- <br /> VVate Supply: Public system [l Community sys tom E] P6vafex <br /> Character of soil to a depth of feet: Sand [j 'Gravel E] Sandy Loam E] Clay Loam E] Clay AJo6 bm Hardpan [] 4�\' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � <br /> (Nm septic tank or cesspool permitted if public sewer is mvaU*6|e within 200 feet.) <br /> Septic Tank: Distance from nearest wel '.....Disfonce from foun6 tion.. � - k4uhoriu| <br /> No. ofcompartments--�� <br /> ------------------Cmpuci+ G,Sizn �4`' J)'/A.x--Uq' }d depth /t .--- <br /> |: Uis+anco'from nearest well----------------Dis+uncnfrom foundation------ ----_Lining mutariuL-_------_----� ~��^ <br /> El Size. Diameter-------------------------------------- ---__--.__--___.___' <br /> Privv ~ D�st nce from nearest well-------------------------------------------------Distance from nearest building_''_-'---''_--_'- � <br /> [] Distance—to nearest lot |l ' <br /> ----- <br /> Numbercf om o+ oodh |� �/�+6 of +n» ch-�������-_-_- <br /> - w <br /> ^ Type of filter mu+er�L���� Do�h of filter material <br /> ._ � repairing ' -�-~ L/ �� —`---------��`�---'----�- -' <br /> --' `rr----- `°'�'a°-^��------'--------'-------------------_---------.-_--- <br /> ---------'-'-'----'-----'---'---'r---'r------------'--------''----'--------'-'--�--------�---------------' � <br /> --------'--------�---------'----'--�--�-----'--------__-____...___.---__'_--_------_- \ <br /> . / hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ^ <br /> ordinances, State laws-and rules an"' , ulations of the San Joaquin Local Health District <br /> (Signed)--------P ---Y---- ------ .(Owner ao/or Contractor) <br /> (Plot plans, showing size of lot, location of system in lelafion to wells, buildings, etc., must be fileowit this application). <br /> . ~.` DEPARTMENT ~~^ =.L. <br /> APPLICATION ACCEPTED BY-04- C--------------------------------------------------------------------- DATE----------1-2 <br /> Alterations and/or recommendations. <br /> . ' <br /> oft <br /> '--'--''------- --°�`� -'--~'~-^---'-~�°~=�-�~�--�-n�"~`�-~^'°-�~��-=' ~^ <br /> __--__''_-''__-'-_''--__-'__.'_-__.''-_-�� --------------------------------------------------------------------------------------------- ------ -------------------- <br /> ---------------------``--'`--'``---'-----------------------`'---'-'---'-------'-----'---------- <br /> PERMIT ISSUED--- /� .�� __'(Dohe) FINAL |NSP ' ON BY:--_ ------------------------------ <br /> Date <br /> _-._.Dote'__- ---------------------------- <br /> SAN <br /> _____SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 1 <br /> - | <br /> 130 South American Street <br /> Stockton, California <br />� so-'9-2w 9-50 W-1639 � <br />' <br />