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-- 'p[�����i��N FOR S����ITA�'I���� Pf 1[T Permit No. <br /> _- <br /> (Complete ' ' Do+o Issued -� l�Z���- <br /> u <br /> mu6o to the Su" Joaquin Local Health District for o permit to construct and install the work herein 6ozri6n6. <br /> This application is made in compliance with County Ordinance No. 549. <br /> -------­------ ------- <br /> JOB ADDRESS AND LOCATION �q-4-2--G � e� -- .__- K �Owner's No « <br /> phnnoA <br /> Address--- Lv <br /> Installation will serve: Residence Ej--7�partment House F] Commercial VZTrailer Court E] Motel L] Other E] <br /> leeNumber of living uni!�, Number of bedrooms -`I,.-1Nurnber of baths .-/-- Lot size - --x- ( i-V ---- <br /> Wafer Supply; Public system Community system E-] Private n Depth to Water Table <br /> Character of soil to a depth of ] feet: Sand O Gravel L] Sandy Loam E] Clay Loam El Oov 0 Adobe T"� 'orclpan F] <br /> Previous Application k4aJo: Yo` [] No [] New Construction: Yes [] No [] <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: " <br /> (No sep ic tank or cesspool permitted if public sewer isavailable within 200 feet.) <br /> Distance from nearest well _--------Distance from foundation--------------------Material -------__________ <br /> No. of compu,tmen|c------ --- -Size------- --- -----Liquid depth------- --'Cupocity---.___-' <br /> Distance from nearest well------ ----------Distance from foundation---.......... -----Distance to nearest lot line................. <br /> Number of lines---_---------------Length of each line---------------_------------- oftrench- <br /> Type of filter material_------------------- 'Dept of filter moh,ri*L Total length <br /> See Distance °o| <br /> Number ofpits--- -Lining mu+oriui -'Size: 'Dept h'A47?.__-___ <br /> Ces,poo|: Distance from nearest well-------------Distance from foundation------ - Lining material - <br /> Size: Diameter--------- ----------- ------- --------Dept - Liquid Capacity-_—''_- <br /> Privy: Distance from noum, well----- ------ - --------- -------------Distance from nearest building------------------------------------------ <br /> El Distance to noono,t lot line_-------------------------._-----.---__—'_----______________ <br /> 3, <br /> '~�_ � <br /> Romo6�iog and/or repairing (6o�cri�A==��--�' ct%��4 <br /> �x�` . - - � ����� -%--''- -'-----''_''-__--_-._---.-.-___-----.__----'____.___--'------.�`~_-_-_..___-'__.----_- <br /> -----'_�_-_''--.-'-_-- --------'__'----'__'_____-___'__-_-_---_.—' <br /> ����`�� .......`������ ����`�����`����`��`�������������������_ <br /> I hereby i 'hat I have prerreegd 0 plication and that the work will be done in accordance with San Joaquin County <br /> ordinan� ta7- ')a-- s, and rules an, _s of r �In Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relafion to w. s, uilding ek. can be p <br /> s, ildiings, ed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------------------------- <br /> ------------------------------ <br /> ----------.�'��������������� ��� ------------------------------------------------------.����.�.��'����������.'���� <br /> 7~' � <br /> FINAL INSPECTIONRY-'/ �'_--- ---- - Da+o ..........------------------------------------------------ <br /> 3ANJOADU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street 3ooWest Oak St.=* /32 Sycamore Street o/+ North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ""_"_," .4S446=°OO" .`° <br />