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~ , c � 0 � � 0��' ' APPLICATION FOR S�`��[7A�� PERMIT Permit No.-==_.-u�-w�_ �/` �wf� ;m 0up||�a� ^ ^- ` Date Issued / k' u/ ' Application is na6v made fo the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. This application is made in compliance*wi,1 #nf Ordinance No. 549. -------------- Owner's Name......... __--_- ' ._ame_.. �^~__'__- -___._--._--_-_`~_._-_--------- P _-_-,--.-.�-__- |msta|lationvill serve: Residence Apartment House [] Commercial E] Trailer �m 0 Other E] �~ � Number uf |�ngun|�: -j Number uf �dmom, -�� Numb� ofbaths I---- Lot size ' -------------'_ Water Supply: Public system IV Community system El Private 0 Depth to Water Table -#d' ft Character of soil to a depth of 3^feet: Sand 0 Gravel E] Sandy Loam E] Clay Loam [3 Clay 0 Adobe Hardpan [] Previous Application Made- Yes [] No K New Cnnstru�+ion' Ye` E] No TYPE OfINSTALLATION AND SPECIFICATIONS: (No septic tank orcesspool permitted ifpublic sewer Yuavailable within 200 feet.) ' 5opt|o Tank: Distance from nearest well------------------Distance from foundation..--r--_-Material ------_-.--+-----_ ' [1 No. pfcompartments----------------------- ---Size--------------------------------Liquid depth--------------------------Capacity----------------------- / ~��/ Disposal Field: Distance from nooro,f °oU.'��Dis+mnoe from foundation-S& f to | line-,-6.�x_--.. Numbe, o[ |in - ~~ Length- of each -n-'r--'' Width ' fr------ ---'--'---' Type of filter materia , �/�^Doo+ of filter mote�aL._K.�------------ o+a| length- -._--__' 1�~^ . ' ` Soepogo Pit: Distance to nearest well _--.--.Distance from foundation--------------------Distance fo nearest lot line.____ ~,~ [1 Number of pits----------------------Lining material----------------------- Diameter-----------------------Depth �--�'�--_-'--- Ces000: Distance from nearest well _---Distance from foundation------------------- Lining material --_---_____- 0 Size: D|umet,c--�''--��--��Dep+ --''--__''-_.''-''''-''Uoui6 ----------------------------gals. _Privy: Distance from nearest well-------------------------------------------------Distance from nearest 6ui|6ing------------------------------------------- Distance' to -.-.-----_._-_-D6fonce' fo nearest lot line_---''--'_--''''-'--__----_.'___-''-'''''__''--'''--_---'---- . ` ------------------------ ' hereby Sfufm law nd es and �rog.ula ions of the 'an Joaquin Lpral Health District. , � ~ ; (Signed) ' Fwgnwp�- --^ - Km � -'.__'__.-_ '-''-~_'-.-'' --'-__--_-''- ��- ----- ��'''-_�----'_--'-'-- ' (�� wells, �� 6o �� m�e side). � . ._. ~.~.`, . . ' - F(]R.DEPARTMENTUSE ONLY. APPLICATION ACCEPTED R,'---�'�_ _''-''''''---'''_- DATE--- - REV|E�/ED BY--------------------------------------------------------------------------------- ---__--__--- O�TE--.��-�._,�..�-.._�______ BUILDING PERMIT ISSUED -----'---'''---''--'''-_-'_-'.'-''''-'-''^_----- DATE'''''.---''--''_---'-�_'____ ` AKonfion, and/or recommendations:------�- - ------------------- ---- --- ---------------------------,''-_.''''---'-''---'',-_',',',.'-`-----------~.-'----------------------------------------------------------------------------------------------------- _ ~ � / '---'---''-'''''-��''''-�'---'�--�� '-��-��-�-''�--''''----''-'--''''��--'�---------- � _--_--_---__--_---._--_--_._----.--_-^.�'-..^-_---_---_----__--_-___.--� ----------------------------------------------- ---------------------- _��__��__--_-------___--_��_��_---__---_---__------ RNAL INSPECTION 8Y:--.-- - -- -- ----- ------------------------ Date-- -----------.---_---- � SANJOAQU|NLOCALHEALTHUISTR|CT oo South e�Xm°riv n Street mmWest Oak Street mz Sycamore Streen/+ North "C" Street ` Stockton,-California Lodi, California Manteca, California Tracy, California s sed^w-2|on .�