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) <br />^ R OFFICE USE.- <br />/--------- <br />' � - -- APPLICATION c� ������ ��� PermitNu. <br />� . <br />r~°"p='e � ~~plic~'~' - Date /mmo6_fA <br />7 <br />� This Permit Ex�ires 1 Year From Date Issued <br />o|icotion is hane6v made to the San Joaquin Local He - |H` District for a permit to con'strct andxin�Ml "herk herein described. <br />This application is made in compliance with County Ordinance No. 549. <br />} ~~- ' --'--- AND --- — <br />I9Q),N .... ..... .. ------ ------------------- / ---- ---------------------- <br />| --- <br />Owner's Name -^` <br />| Add --'''-'---''----'---'-''-----' <br />Contractor's Name --- �~�K�x���-��.c/cs^.._--_-----------,-.--------------- ....~----------,--- <br />� <br />Installation will serve, Residence tr_­Apartment House [I Commercial 0 Trailer Court Motel E] Other El <br />` <br />Number nfliving units -�- Number of bedrooms um6er of 6a+6x /-.- Lot size �p.���,���~-----------' <br />���� . ��~~ <br />| VY�e Supply: Public system[� CCommunitysystemsystem��� Private 0 Depth +n Water Table _Z -Off, <br />' <br />Character of soil to e depth of feet: Sand [] Gravely Loam E] Clay Loam [:1 Clay [] Adobe PT- Hurdcmo [] <br />-- ` * _'^� <br />P,a°|nus Application Made: Ufyes, 6oto.^-.- --.---) No QN^� Now Construction: Yo, 0�'~N, [] FHA/VA.YesE] No�] <br />/ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />0 se k or cesspool permitted if public sewer is available within 200 feet.) ' <br />. f compartments --------------_------ -- Size Liquid depth - Capacity ' <br />D U Distance + foundation <br />Number of lines <br />' <br />Type of filter motena-70 <br />_����xx�x�,uep, of filter m«r;n*/1---------------- '"'"' ength -------- 1747 ---------- <br />Distance ronoure, u/u*"------ <br />Number <br />/ �r~ Num��,o[pDs._.��---..Uning material ------------ Size: [Xo==+-c..��"�----Dep+�'�u���..-�-'--- <br />-_ d .0' - <br />Cesspool: Distance from nearest well ----------------- from foundation- ------------ Lining m*toraL.-''--'_--�-'_- <br />��v� D�ma+ec.--�--�_���----Doo�------..�--�-----_.Uqul6 Cupoci��'--_.---_.gu�. <br />-� . ' <br />Privy: Distance �om'nourrs weU''�.--'�-'-''''-'''--Di�*nuv from nearest building '-''_----------------- _'-------- <br />[] Distance to nearest lot line -'�-r-.,---------`'-__-_._-'_-____--__..�,_._����____ <br />. <br />� <br />` ` ' <br />Remodeling and/or �puih du��bo:. � -~ --._-_-_'-__.-_--_--'''-_.-_---'-'-'----'-'' <br />_-_-.--__-----------'-'''_-.--_ ------------------------------------------------------------------------------------------- ----------------------- <br />' <br />-----'-'''-'--'--'-'--''--'--ordinances, State li s, a, rules and regA4 <br />-- <br />By: -------------------- _ ---------------------- :L <br />(Plot �lan, showing size of lot, locition of ! <br />_ <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ------ --------- --------- r!7 _ ----------------- - -------- ---------------------- <br />---------------------------------- <br />------------------- <br />S rNJOAQUIN LOCAL HEALTH DISTRICT <br />1601 E, Haxelton A4. 30 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />