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/ ^ <br /> � ` ' ' <br /> APPLICATIONFOR <br /> ~7 - ,� /y "� __ �p�[����� FOR ����� PERMIT�T� ��� �T Porm� N�7� � _ <br /> A��m���� in �u�|�c��) � <br /> ' ' <br /> Date |ovv6 n/ � <br /> /\ <br /> o|�u#u# � here�vmo6etuH`eSanJooquinLoon| Hen|H` Di��cffor upermit tpcpn�m �ot �m6 �nn��|| H`enn, 6ane/ ���'|6v6� | <br /> |hi <br /> application idi |i ithC 6 � - ' <br /> JOB ADDRESS AND | <br /> v/v--------6,ju I d <1--- ...... <br /> Owner's Name A_C___r.r---f <br /> Trailer Court E] Motel El Ofker E] <br /> Installation will serve: Residence E]' Apartment House 0 Commercial x <br /> Umber of baths _7n7�1_ot size <br /> Number of living units: --Number of bedrooms N ---�?P_ <br /> Water Supply: Public system X Community system C1 Private E] Depth fo Wafer Tableo--- ft. <br /> Character of soil to - depth- of- feet: --- F] Gravel E] S~^~' Loam El ~~x Loam El `^a' El Adobe JmU Hardpan <br /> Yes E] No New Construction: Yes F <br /> Previous Applicafii�n Made. _] No <br /> /rrE OF INSTALLATION AND <br />/ (NSPECIFICATIONS- <br /> m �m� om�p�� permitted if public sewer wavailable within 200 feet.) <br /> Sepfic I Tad Distance from nearest well------------------Distance from foundation-------------------Material <br />. -- No. of compartments---------------------- -----Size--------------------------------Liquid depth--------------------------Capacity-----'-_'. <br />` D i | Field: D�stunce from nearest woU. -0i0nco from [oundrf Distance f6 nearest Jet line- <br /> Number <br /> Number of lines�- 719­ Length of each line �V�+ off�nch. <br /> / - Typo o[ �|+o, mo+vr|o| Y'�'��1m�{��'�Depfh of �|to, material--- -_ --------- |eng+k-- -'-------' <br /> Seepage Pit: Distance to nearest well---------------------Distance from foun6ut�on___----Distance to nearest lot line_---- <br />, 0 Number ofpits--.-I '---��''Lining material----------------------- D|umetar'--'_-'--Deo+ --------------------------------- <br /> Cesspool: <br /> ------_.-__Coo,poo|: Distance from nearest well------------------Distance from fmun6ot�on.----------- Lining mo6yrivL--._-_-_-''- <br /> [] Size: Diameter ..----------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- <br />; Privy: Distance from nearest wO--�����--'''--''--'''-Disf nce from nearest building.'---'__-'__.'--'- <br /> L1 D�sfano: +onearest lot line <br /> _--------______________._______________._.____ _. <br /> Remodeling and/or repairing (describe) <br />` --______________.__._____._____`.____ -'�cmxw--_. -- ------ <br />, -------------------------------------------------------------- ..--------- --------------------------------------------------------------------------------- -------------------------------------------------------------- <br />� _'-'-__-'-_.'_---''_-'-_----'''___'--___.-_--'-__'--_-_--.___-.--_-__,--- <br /> I hn e Lre 6 certify that I have pre�a� d I 1�,,!.applfication and that the work will be done in accordance <br /> with San Joaquin County <br /> ordinances. e law,:4 s a i s o the San Joa in 0 ealth District. <br /> Tif <br /> (� plan, showing size �Iocafion in ��� ���� buildings, �. �`� ' -- ----- <br /> , placed- reverse --�. <br /> FOR DEPARTMENT USE ONLY <br /> xEUEvv±D UY------------ <br /> '— ----------- <br /> ------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- <br /> -'--'--''----'-^'--- ' <br /> ''- '-_-''''-''`,--'''�'~_''''__--'_--'^'-'_--'-_-'-_.�''__''-'-'-''_-.'-- <br /> -._------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- <br /> " � ` <br /> � <br /> FINAL INSPECTION BY:'-'''���!��p�� -''-_'-'---- Du+e'''''' ' �~--� '-''__.__. <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> ou south American Street ' 300 West Oak street mz Sycamore Street ow North "C" Street <br /> Stockton, California \ Lodi, California M°n*oum. 00|a"rn|o Tracy, California <br /> ES-9-2M va/ no.uma vv�2/00 <br /> � <br />