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| �0Number of �eclrooms � <br /> This Permit Expires I Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and ins;al��the work herein described. <br /> This applicaf'�n is made in complianc ifK'C._pu-_-OrdtWnce N' 9. <br /> Owner's Nam <br /> -----------i............. ------ ...................................................................x­ <br /> Installation will serve: Residence Apartment House E] Commercial [-] Trailer Court IMotel [] Other C] �7 <br /> 4 Lot size <br /> Number of living units: <br /> ' � " Number of ths <br /> Water Supply: Public system [] Community [] �� to Water g_ ft <br /> Character ufsoil towdeo+& w�� f�mf Sandd <br /> ��,ove| [] (�|uyLoum [] C| y [] /\6o6w-`-� undpun []'��� ^� -- - � �u ' 'Prev� Ap �cmf K4 d (|f 6 ) N mm^~ e'w Construction: Yes E] No mn^�F ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if'pubric sewer is available within 200 feet.) <br /> Sep;t' T k: Distance from nearest �ell__$q Distance from foyndation----/10_11__.M a,terja....... <br /> Disposal Field: Distance from near well.6-Z------Distance from found;_tioZ_ /..47_ I-----Distance to nearest lot line................. <br /> Number of lines._. Length of each I Width of trench_- -­ ----------- <br /> ------- <br /> Cesspool: Distance from nearest well -----'Distance from foundation--------------------Lining material -.--_----.'........ � <br /> 13 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------'-gu}o. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building.--__----__.---.--- <br /> [] Distance fonearest Iofline-''---''---''''---'-__-'____--_-'--�''''--_.'-'--'''------' <br /> Romodel|ng and/or repairing (describe):-------------------------------------------------------------------------------------------------------- .......... <br /> _____'_--------------------.........___----------------------- -------------------------- _'_____________________________'__________ <br /> � ' <br /> ---------------................................................... ''-----------'--'---''''--'--------'----''--''--'—''------'' <br /> r_ ~ ' ~ ^ `� <br />