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/ <br /> ° <br /> , <br /> ' � �� - <br /> �,A�[�A���N FOR SAN�ATONm�nm� Ponn� Nu -�� --------- <br /> � . , <br /> (Complete— - � Cu��fe) Dofn IssuedApplication is hereby made to the Sa� Joaquin Local Health District for a permit to construct and install the work herei ribed. <br /> This application is made in compliance w�h County Ordinance No. 549. <br /> ,741 <br /> rk veriribecl, <br /> IYNDLO <br /> Installation will serve: Residence E] Apartment House E] Commercial [3 Trailer Court 0 Motel r <br /> Wafer Supply: Public system 0 Community system Ej Private E] Depth t� Water Table ff. <br /> Character of soil to a depth of 3 feet: Sand �rGravel E] Sandy Loam E] Clay Loam E] Clay [-] Adobe[] Hardpan <br /> Previous Application Made: Yes E] No Rqr'- New Construction: Yes E] No g+- TT-IA/VA: Yes F-1 No E�j— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> �— ]No septic �� or.cesspool if public sewer,is. available within 200 feet.) ' <br /> epti lank: Distance from nearest well-----------------Distance from foundation--------------------Material ------------------------------ -._ <br /> Liquid 6 <br /> ispos ielWd: istance from nearest well- Distance from founclation--/-e-------Distance to nearest lot line--- <br /> Ad Depth of filter materia <br /> ' Total length <br /> IOAP 11^ <br /> Soopogu Pit: Distance to nemny�twell '''-'''-''Distance.from � <br /> foun6��on_-'____�0�+onn: to nnmrvo �� |ino-''-'-' <br /> El . Number of pifs.-/--------~Uning material----------------------- Diameter.---.—_--Depth---'—.----- 9� <br /> Compon|' Distance from nearest well Distance from foundation Lining mo+n,ia| � <br /> ow' namooelmg anu/or n,pumng |o�ocno�F---------.�4�����--...�«.n°��m~o �----------.---------- <br /> ---___.__-__..__..---__.-----�-..__.-_-___--_._-_-__-_'_.__.__'___-'----_-___-_--.. <br /> -_---_-__.___'-..___..--_--'^-.__.___-__-----.-____.---_--____.-`_-_-.___._._-_-_-_- <br /> ----------------''--_'-.--''_--L.''-_-.-_---__.-__--_.'-__'-_-'''-_-_---_-'_---_.'-''-''-'-'-''--' <br /> I hereby certify that | have prepared this application andthat +hmwork will be done in accordance with San Joaquin County <br /> ordinance$, State .laws, <br /> andr Iles and ir!,gulafi"s of the San Joaquin Local Health Disfricf. <br /> (Signed) ��c�u <br /> � <br /> ijo a; <br /> (Plot plan, showing size of lot, locaiii�n system in rel�fion to wells, buildings, efc''.-, can be p'l�ced on reverse side).- <br /> FORDEPARTMGNTUSEONLY <br /> ,`,,"`-"..`^.` ,`~`~E,.E° ". ----- -'-------.----.--_---' ~'`.^_-~.-__.---------_---- . <br /> REVIEWED BY-------------I---------------��.'l.-� Q/\7E <br /> BU|LD|NG PERMIT ISSUED--'- ---'-_---------------------------- DATE_ <br /> � � �A�w,*���ns and/or rn�ommon6eMono�. -----------------.----.�,--------------_ � ------------------------------------------- <br /> ---------------------------------------------------------'----�---------'—'----'-----'-'------'-----'---------------' <br /> '-'----''---'-------'''-----''''-'''-'''-'''-''''--'--''--''--'--------''''--''--'--'------'--'- <br /> \. <br /> . .—___._-_--_----_-~-��—.__----_-_--'_---.-/_--_-_l�--_1--__L <br /> -__ <br /> ------_- ---------- <br /> ---------------------------------- <br /> __ <br /> _________________��_��____ ' V __________ ' _�_______________.' <br /> �N/ L INSPECTION 8Y�''-- Dn+e --» '�- ---'-'''------_ <br /> SAN .. <br /> �[�k��|N L�u�ALHE�LTH �|�T�K�T <br /> ' <br /> ou South American stro"w 300 West Oak Street /xz svmmnm Street 814 North "C' o*me+ <br /> Stockton, California Lodi, California Manteca, California nmwv, California <br /> cS -9-2w . Revised ,'5r p.,oz � <br />