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` <br /> / Y_9 <br /> - 741L. / JCATION FOR SANITATION PER` Permit No. <br /> --------------------------------------------------------- (Complete in Duplicate) <br /> Date |souu6 --�'���L�J�� <br /> Application is hereby made to the San Joaquin Local Hao|H` District for u permit to construct and install the work herein described. <br /> This application is made incompliance with County Ordinance No. 649. <br /> JOB ADDRESS AND LOCATION. _____________._____.___.__ ________ <br /> Owner's <br /> N ��� <br /> -,��~e�u�]��-°------_-----_-_-----_.---_-------. Phuno_.'.�-..-.������v�- <br /> A66mas-'- _____________________________.____.__________________ <br /> Contractor's Numo- ----------------------------------------------------------------------------------------------------------­­­­­ <br /> Phone <br /> Installation will serve; Residence F] Apartment House [] Commercial X Trailer Court [] Motel [] Other [] <br /> Number ofliving units: -------- Number ufbedrooms -------- Number ofbuH,sA '- Lot size ......��.'�,..~�'^�.�� ...............--- <br /> Water Supply: Public system 0 Community system [] Private F1 Depth to Water �ble-?�.5 . ft. <br /> Character of soil to a depth wf'3 feet: Sand [] 'Gravel [] Sandy Loam [] Clay Loam [] Clay [] A6o6eQM Hardpan [] <br /> Previous Application Made: (if yes,date----_--.} No p New Construction: Yes [-] No [V FHA/VA: Yes [] No �� <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (Nm septic tank or cesspool permitted if public sewer isavailable within 200 feet.) <br /> Septic Ta Distance from nearest well----------------Distance fn,m6u+ion--_-----WuteriuL.���^������.--_.-_ <br /> No. of compurtnonts--.-':� .'.-3izo^r�' 6���.�P--------Liquid depth------#./-------------Capacity... _-' <br /> DiField: Distance from rest ---Distance from foundation Distance to nearest lot | <br /> Seop*g* Pit: Distance to nearest �o Distance from foundation ��-2_0' Distance to nearest lot line ���/ <br /> O0 Number ofpits....../-------------LioingDiumeto,-W.8°---------Dept h---as5_1.................... <br /> Cesspool: Distance from "ov,os well..................Distance from foundation -------Lining mu+oriuL---'----.-_.--.-. \ <br /> [] Size: Diameter ---.-%------------ .�Daot ----------------------------------------------------Liquid Capacity---------------------------- <br /> Privy: Distance from nowrettwell .--_--' ''Distance from nearest building-----'---___._._.- <br /> [] Distance to nearest lot line--_-_-__-'----_-' .--_._-_-_-_-_-------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S laws,;nd and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------...................................... D/g'E-._---._------__'__-_ <br /> + � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street xnnWest Oak Street 1x*Sycamore Street 2o5West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> =."°=="="-"","==.°°"."= <br />