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} ~^- <br /> APPLICATION FOR S. -.41TATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> plica;ion is hereby made to the San Joaquin Local Health District for a permit to construct and insfAh3;ork herein <br /> '_ application_ - made in compliance with County Ordinance No. 549 ' <br /> JOB ADDRESS AND LOCATION .41 <br /> 10 <br /> Addres <br /> Contract4 ame---------- ------------------------------------------- ----------------------------------------------------------- Phone--------------------------------- <br /> Installation will serve: Residence)e Apartment House E] Commercial E] Trailer Court E] Motel [j Other El <br /> ------------------------------- <br /> Wafer --rrr Public system 0 Community— — system`-- ^~ Priva tex Depth <br /> Character of soil to m depth of 3 feet: Sand [3 Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe k3l Hardpan � <br /> Previous Apr.~.._ Made: Yes E] N0 New Construction: Yo� .o [ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank orcesspool permitted if public sewer i, available within 200 feet.) <br /> ptic Tal Distance from nearest *eU`-----Distance from foundation-------MutvrioL------------.---� <br /> Nu of compartments Size_--------.--Uquid 6op+h--------..Cupudty--------. <br /> 4D Distance from nooms+ well------ ----- -Oistoncu from foundation-------------------Distance to nearest lot line--_--- <br /> Numbvr o[ lines-----------------------------------Length of each |�no------------------------------Width offrench-''--'-''-'-- <br /> Type of filter mo+er�mL--'� ----------Depth of filter material---------- ------ ''To+ | length------------------------------------------ <br /> - <br /> teepagt� D;�uno, fo �o /�� ^ D ncofo Number of pits-��-----Lining mu+vri �� Size: Diometor-..~�----..Depth-..*�o�------- <br /> Cesspool: Distance from nearest wu|-----------------Distance from foundation - -----------------Lining moteriaL--._._--_._ �U� <br /> [] Size. Diameter --''-'''_---Deo+�-'''--'''-'----''_�qu@ Cupm���'--'-'-''--gm�. - <br /> . <br /> Privy: Disfance 6nm nearest well ------ --------------------------------------Distance from nearest building-------------------------_.-'-- <br /> [] Distance to nearest lot line- <br /> I here6y certify A - have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws.Aan rules and regulations of the San Joaquin Local Health District. <br /> By: -------------------------?O� ),Oe <br /> (Plot plan. showing sixe of location of system in relation to wells, buildings, etc., can be pi ed reverse side). <br /> DEPARTMENT USE ONLY <br /> xu|Lu|wG rEmm|/ ISSUED-------------------- --------^ -- -------------------- u^/E ---_-- <br /> A�e,a+�nxand/or ,ecommen6a+�rm:-----��- ------_--_--_-._----_-_-_�`.�/.�_ ._'--_.-- <br /> -` --'`---------'--`` <br /> R <br /> ._---- �, --==-.�'=�--..~..'~�-. —_-^�~��._--.__-_---_-_---_.__--' <br /> --'----'' -----'------------------t�'�'------------------------ ----------------- ----------------------- -- ------------------------ <br /> -------------------------------- ^ --------------- ------------ ---------------- ------------------- --- - -''--''-''--''--''''''-''--'-'-'-_'-'_----' <br /> FIN/\L INSPECTION BY:---- -------------- Dotn'- ..)r./° .......�\'��_----_._- <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> /30 s*ufh America" Street 300West Oak street /32 Sycarnore Sfreet mw North "C" Streof <br /> Stockton, California Lodi. California k8*m**w. c"|nomi° Tracy, California <br /> "°_*_"M `45^°~~.^" ."-s� <br />