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. _ <br /> -,OR OPPICE USE: <br /> (Complete in-Duplicafe) Date Issued <br /> -hade to the San Joaquin Loca . or arm <br /> Application is hereby r _�Kleal+h District f if to construct an fall the work herein described. <br /> This application is made in compliance with Cou5W-Drcli"n? N 9. <br /> Address- <br /> Installation will serve: Residence Apartment House E] ornmercial [-] Trailer Court E] I Motel E] Other E-] <br /> Water Supply: Public system E] I rr�prli=, <br /> (-ommunity system Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 5g-<ra`vLom Clay F] Adobe[] Hardpan E] <br /> TYPE OF INSTALLATION AND SPECiFICATIONS. <br /> (No Septic tank or cesspool permitted if blic wer is available within 200 feet) <br /> is <br /> Septic Distance from nearest w Di t ' o f <br /> arest well ll�---------Distance from foundaf ion--/*#. 9;efance to nearest tp; <br /> Seepage Pit: Distance to nearest well------ ----- -- -----Distance from foundation------------------ Distance to nearest lot line----------------- tA <br /> Ce` poo : Distance from n6una+ well-----------------Distance from foundation................... Lining material —'-------- �--'''- m�~~ � <br /> 6ize: Diameter � --------------- ---- ---------- Duo+ -------_--�� --------------------- Cupo6�� .gu6. °�' <br /> t � . ��--'-''-'-' �� . <br />! � Privy: Distance from nearest well-------- from nearest building--------- .�'�--''-'''_- <br />' FJ� Distance to neone,+ |o+ line-----. --------------------------- ----------_--�_-'-_---_._--_------------ <br /> �___Romodeing vnd/br repairing (describe):-------- �''—��''-'''--'__--''_-'''__.-----_�__'___________-_______ <br /> ^ <br />` -- ------------------------ __-�----'-_-''--''_--'--. <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- <br /> I hereby certify fh�o I have pre�ared this application and that.the work will be done in accordance with San Joaquin County <br /> ordinance5, State rules and regula ions of +he San Joaquin L ealfh District. <br /> (Sigff <br /> ------ ZI------- - ---- --- - --------- <br /> (Plot plan, showing size of lot, location of system in r I fion to Is, 6uildings, e can be placed on reverse side). <br /> FOR DEPARTMENT USE ON�Y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Locli,California Manteca,California Tracy,California <br />