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� <br /> jqrSV <br /> � <br /> ' /Y �������� ��� �������� ���� Permit o. <br /> n <br /> r~='v°== in D"r^~='~/ Date Issued ----------� ^~ <br /> San Joaquin Local Health District for a permit to construct and install the worherein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> Installation will serve: Residence ff-"A"partment House E] Commercial Tra;ler Court F1 Motel 0 Other [I <br /> Lot size -----/. ......................... <br /> Number of living units: ---I---- Number of bedrooms .�� Number of baths --- <br /> Water Supply: Public system 2/community system [I Private Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam [-] Clay Loam [:] 'Clay E] Adobe E]-"'Hardpan 0 <br /> Previous Application Made: (If yes,clote--------------------) No [OXNew Construction: Yes JQ,"No [:] FHA/VA- Yes [] No E]-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 3rptic Tank: Distance from neorestweU------D|stanco from foundo+ion...................Material ----.--.............................. <br /> No. of compartments---_--__.Size--------------------------------Liquid 6epfh--------------------------capacity....................... <br /> F. <br /> Disposal l Distance from nearest well----------------- from foundation--------------------Distance to nearest lot line................. <br /> Number of lines-----------------------------------Length of each line------------------------------Width of french................................- � »� <br /> " Typo of filter motoriuL-'''_'- Depth of filter material -Totu __' <br /> 8�� Distance to nautweL.� �... D to nearest��� —n / <br /> �� ' '-__'Num6wr of p��._ __--Un|n � . � <br /> : <br /> Distance from nearest well -'''-'-Distance from foundation —''-'--Lining ma+e,iaL-'''-_-'------ <br /> F] Size: Diameter ----_-_-----------Depth---------------------------------------------- ...Liquid Capacity----------------------------gals. <br /> Privy Distance from noorno wpU-------------------------- ------------------Distance from nearest building......................................... <br /> [] <br /> Distance to nearest [of line'''—''''---''�-'''' ------------------------------------------------------------------'-'--'--'-' <br /> �� <br /> Romo6eJing and/or repairing (describe):--. --��2.6�����=./��V�--J��..���um�� � _'1���.�`��ua'1--' <br /> .._._.._.._____________._____--_-_-_-_--'-.......-'-�_----_.--------_-.--!.-----'...----. ..-.-.-y-.----'-'' <br /> -_.—____-__--_--''.----..-°..___-_-.__.___--'-_.—__...---..---'___._._..____--__._.__-.. <br /> - <br />. hereby certify that I have prepariii d this application and that the work will be done in accordance with San Joaquin County <br /> ordipancm-Stale laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan. showing sizeli-I-o--t-, location of system in relation to wells, buildings, etc.. can be placed on reverse ls,_ri e-). <br /> FO�_DEPA"WT USE ONLY <br /> Altermtionoand/*r :------------------------------ ---------------------...........- ------------------------------------------------------------------------------------------ <br /> --------------------------------------------------- '-''--'''--''-''---'''-''''---'--'- ..............------------------------------------------------------------------------- <br /> ----------.............................. --------- ----------------- ------- -------------- --------------------------------------------------- ................. -----------------------------------------------------' <br /> ---------------------------- -'—'--''---''-''-''''-''--''''-''---------------------------------------------------------- '''-----'---------'---------------------- <br /> ----------- ........................ __­ _ � __________________________________________ <br /> RN^�L INSPECTION BY:...... --../�~/.���.� ----- Date. <br /> ..��--------- <br /> SA� J���U|11N LOCAL HEALTH DISTRICT <br /> 1onSouth American Street awvWest Oak Street `zoSycamore Street u0wWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> m ° REVISED o'o° nM "'°' ATLAS <br />