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FOR OFFICE USE: -'------' - F��R� �� Permit No | . APPLICATION ' ' , ` . � . �-- � (Complete in �°r"�'=, Date [$sued � ---' Issued ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and installthe work h ��,c,�ed � This application is made in compliance with County Ordinance No. 549. ID&C-44�LL-0 � JOB ADDRESS AND B--------- - ------------------ Installation will serve: Residence A- Apartment House 0 Commercial [] Trailer Court [D Motel [] Other [3 Number of living units: _1---- Number of bedrooms Number of baths J---- Lot size ---- -�Ar_4<_.R ....... Water Supply: Public system El Community system E] PriVate gr-5epth to Water Table'T ft. Character ofsoil toadepth of 3 feef: Sand-C] Gravel F1 Sandy Loami uay LoamU Clay C] Adobe 0 Hardpanu '. Previous Application Made: (if yes'6omo--------------------) No [-] New Construction: Yes [] No [] FHA/VA. Yes [] Nmo | TYPE -OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permifted if public sewer is available within 200 feet.)- Se k: Distance from nearest well___50-----Distance frQm foundation---A9------ - M t - 1 Disposal Field: Distance from nearest well-_NSD------Distance from foundation-_10......Distance to nearest lot line......t57.— S000mgo R+: Distance to oeom"t well-------- from foundation-------------------Distance fo nearest lot line � � Number of pits----------------------Lining material-----------------------Size: Diameter_.....................Depth---------------------_-'' | : Distance fnzm" U Distance from foundation Lining ma+mri | [] Size: Dia Privy- Distance from noon�+ we|L�'''-r�z -----' ------------------Distance from nearest building------ ---_--__--'-- [] Distance tonearest lot line-------------------�--------.___-._----_..--'-________--_._.______ Romo6ning and/or repairing �_------._-------��'�-___..-------._---____-.-_.-_.__''_ � '4. '--'----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------- '�------- -------------------------------_.'-'-'- .--.__..__.-'__-_--__..-__--___.--___-___--'-.-__-_____.-._--_.'-_--_._-'-'--_.'-'-_ have prepared this application and that the work will be done in accordance with San Joaquin County - ordinances, State laws, and rules and regulations nfthe San Joaquin Local Health District. ' � - --_--------.-----.------AOwnmr and/or Contractor) ` ._--_-.-u/ -�_—_'-_--'—__-_- _----_----------' \ � (pk�� s�� 7 �+ |p�� m yn�e|mfKon to wells-, bui|dYngs, ef�. canbe p��d on reverse �6m� - -- ----- :., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By-------__---P�------------- " REY}EVVED BY----------------------------------------------- ------------------------------------------------ ----------------------------- DATE----------------------------------- « BUILDING PERMIT ISSUED--------------------------------------------------------------_-------------------------------------- DATE.--__--'-._----.—..-_'._ AN,aGons and/or ------------------------------------- ----------------------------------------_--------------------------------------------------------------------------- ---------------------------------------- - 6--------e -----------_-.—.--_--____.__-_-___._- -' -''-__'''-_.-'--'---___.''''---'-_---'-_- --_-_.. --._-'_--_-_--_----.--.=----_-- ---'-' -'—'---''---''''''--'''---''--''-'--'--'---' ! FINAL |NSP �i/— ^` Omt='''''_ ... .'2— '--''-'— SANJOAQU]NLOCAL HEALTH DISTRICT 130 South American Street mmWest Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California wm"wca'Ca/w^rmm Tracy,California ,u 9 vEnum x'59 o~ °'°/ mL^"