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- . . pL|C/\l\{)N ii-{]R 3/\N|TAT|C)KJ PEwn�[T prnn� No. <br /> (Complete in Duplicate) <br /> Du+a Issued <br /> - <br /> Application is hereby moJa to the San Joaquin Local Hov|H` District for u permit to construct and install the work herein described. <br /> This application is made in compliance <br /> JDD /\DDKE33 /\ ' <br /> - ---- <br /> Owner's Name--- ---------------------_ --------------------------------------- ---------------------------------- - <br /> Installation will serve: Residence E] Apartment House E] Commercial J�j Trailer Court E] Motel E] Other E] <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size <br /> Wafer Supply: Public system D Community system D Private Depth to Water Table ft. <br /> Character of mU to a depth of feet: Sand 0 Gravel 0 Sandy Loam E] Clay Loam D Clay [] Adobe 0 Hardpan �� <br /> Previous Application k4oJo: Yes [] No 2 New Construction: Yes No [l FHA/VA. Yes [] No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool po,mH|eJ if public ,e*o, is available within 200 feet.) <br /> - <br /> Septic Tank: Distance from nearest woU. ..f^'Dis+unce from foundation-----/'�0'.--Wu+eriaL' -____-_ <br /> No. ofcompartments''�------------------S i z e S~----Liquid 6eFfh-..�/-----.Cupud��.- ......... <br /> Di,pco6| Field: Distance from nearest weU'k$.^--Dio+unco from foundation----1�.'*,.._-Distanco to nearest lot line.--,-- --------- <br /> Number of lines----/. Length of each <br /> Type of filter --'Dop+k of Q+or moh,rioL.-/O�............. length-----0.!0--------------------_---- <br /> Seepage <br /> --_____.'--Seo ge Pit: Distance to nearest well-_/_&P----------- �- - Distance to nea�oflot |in~ �`�.- <br /> Number of pH,-'/-_''-Uning motoriu| ------Size: Diameter ° _-Dopf6 I~4�/_------ <br /> Cesspool: Distance from nearest well -----.Distance from foundation-------------------- material -----------' <br /> [] Size: Diameter--------- ----------------------------Depth----------------------------------------------------Liquid Capacity ------------------------gals. 0� <br /> - Privy: Distance from nearest well -----_---'-----Distance from nearest building---- - ------------------------------ <br /> F] Distance to nnon,s+ |n+ line--------------------------------------- -------------------------------------------------------------------------- --------- ____ [� <br /> w=' Remo6eling ov6/o, repairing ldescribe):--_'____________. ---------------------------------------------------- XA <br /> -- ��������------------.------'------ � <br /> I hereby <br /> ordinances S jfel�_�S_Pncl rules and regulations of the San Joaquin Local Health District. <br /> - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED -1 <br /> _ <br /> REVIEWED BY-------------- <br /> -------_..---.--_._-.___'_-._--�_'____--.--'_-' DATE <br /> .__--___-__-__'___-__' <br /> BU|U}|NGPEKW|T |SSUE -----' DATE'- <br /> Altx, 6nnsvo6/n, ,000mmon6a6on,;__._-____-__--_-'_-_--_____-.___-.__'_-____'___...__--______ <br /> -_-----'-------._----___----_------_--.____-___'._-__-----_-_------__--_-----_--_ <br /> ------------` ------------------`------------------`--------- <br /> -------'---------'----'----------'--------'---'---------'--'--------'----- <br /> ---------------------- ------------------ -----'- -------------- ------____-------------------_-- --__------------------_ <br /> � <br /> FINAL |NSPE[T|ON RY�� -'-� Du+o/�� ~ � --~\-' -.--''-' <br /> _ I4WJOAQU|N LOCAL HEALTH DISTRICT <br /> oo azum American Street 300 West Oak Street 132 4""m"," Street m* North ^c' st,"°+ <br /> s+=eo". California Lodi, California w""te"", California r,",/, California <br /> ES-9-2M Re~is°u 1a7p.poz <br />