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^ <br /> AP ���Tk�� ��� �����T ��� ����[� <br /> . . <br /> ' <br /> (Complete in Duplicate) <br /> , <br /> Application is hen,6, made to the San Joaquin Local Health District for a permit to consfruct and install the work herein described, <br /> This application is made in compliance wifh Count Ordinance No. 54JOB ADDRESS A 4 \ <br />- O°"or: nome.- <br /> Installation will serve: Residence &'* Apartment House E] Commercial E] Trailer Court Motel E] Other F-1 <br /> Number of living units:. Ej Number of bedrooms [] Number of baths E] Lot size <br /> Water Supply: Public system El Community system E] Private F-1 � I <br /> C haracfer of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam IJ Clay Loam El Clay 0 Adobe 1:1 Hardpan El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from "Material <br /> o <br /> Cessp 1: Distance from nearest weil Distance fro� joundation-_-Z---------Lining material------- ---------------- <br /> Field: Distance from nearest Well------------- <br /> Remodelin and/ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ' ordinances, State law--' -- ~~' Joaquin L~""' Health ^°,trmr <br /> G;o __. _�________ �_�/__ y_ <br /> ^ - ' - --'---'—�-------------�~^~'^~ a�/", �o"tr*nnpq ' <br /> By:---'___..____._____�_-_.._____._--___.____�____.__ _. � <br /> (Plot plans, s�enf�t location of system in relation to wells, buildings, etc., must' be 'filed . this--''----'---'''-'— <br /> FOR DEPARTMENT USE ONLY <br /> _ ^ <br /> ----7 <br /> V111(f------ hdw---- --------------------- ---- <br /> I .j <br /> �r » <br /> PERM|T N |3SUE�-No----- � -(Do|o) FIN/\L INSPECTION BY:----- <br /> Ovt�'''___ <br /> \ � \ <br /> SAN J[�AQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street - <br /> Stockton, California � <br /> ES-9-2M v'so W--1639 ` <br />