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� ��' ~~'� <br /> �� 4 �� {� � <br /> ` ` �������������Y� ����� �������k������ ������� Pmnn� Nu ~��.--,=-.�. <br /> k��nnp|�f� �n �u�|��mtm <br /> ^ ' Duh, Issued <br /> \ Apn|icu+ion is hereby made to the San Joaquin Local Hvo|+h District for u pe || -lk �6 6b6 <br /> Thapplication6 | h County Ordinance <br /> J`�» r`uunESomx --~- - <br /> �_----------/--------- ------------------------------------------- PhoAV:5;5��-P-7­,7-S <br /> ontractor's Name_&4fA_� <br /> Installation will serve: Residence [Z Apartment House 0 Commercial [-] Trailer Court E] Motel P Other E] <br /> Number of living units: Number of bedrooms Z-.. Number pf baths/)�<Ot size ----�11------ ---------------- <br /> Water Supply: Public system Ej Community system E] Private RfrDepth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam Clay 0 Adobe 2--lHardpan <br /> Previous Application Made: Yes [] No e New Construction: Yes 2"'No El <br /> (No septic tank or cesspool permitted R ubliF sewer is availablewithin 200 feet ' <br /> 5m nk: Distance f f, fo <br /> junption- J- <br /> D|spo�| ��J: 6n | <br /> �� �-'-- - -�--' � --_ -lin_ / Width of trench_- ` <br /> Tvmo of filter m Depth of filter material --1 --L''Total length----------- ----------------- <br /> Seepage <br /> --___Seopogn Pit: Distance to nnam,tweL------Distance from foundation--------------------Distance fo nearest lot line_.__-. <br /> F] Number of pits-'-'''_--Uning material-----------------------Size: Diameter-----------------------Depth-------------------------------- r <br /> Cesspool: Distance from nearest well----------------Distance from foundution-��--/-. Lining material -------- ____ ' <br /> [� Size: Diameter-------------------------------------- ----------------------------------------------------Liquid Cupuc�y.-_--_--_gals. <br /> Privy- Distance from nearest well '--'-'''-''''-''---Distance 6nm,ovan,sf 6u86ing'_'--''-________ � <br /> 11 Distance to "eu,u,f |o+ line---------------------------------------------_._--._.__--_._-_--_-.-_-_.__-- <br /> Rem <br /> e .-'---'-'---''__.-____-_-.----------_--_-------_-__'-_.'--.--_-----'--.'--.--'-----'_-.-__-_-----_�-'-'- <br /> `--`---`--'`--`------'----.-_--'----''----------''-------------'----'-----'---- <br /> --'--'---'-_-'-''-_--'__-_.'_-_-.''__'-__.___---_-'-_--__.'''__.__--__'_-_-_--''-'''-''-'-��- <br /> | <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ,din nd m|oo and regulations of the San Joaquin Local Health District. <br /> (Signed)-, - ------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:..-____----.-._''__--�'_---_-_----..__.--_---_/Title1-----.__________.__� <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B -------- <br /> ------`----------`--------`-----`-------`---------`````-----`�� --`�`----```-------`-------``--------------------`-------`-----------------``----------------------``---------'------'------'--- <br /> ---------------------------- <br /> ---------- ------ . <br /> -'-''-''--'''—''-'''-'''''--'''-'''--''''-'''-'-'---'--'''--'''--'--''''--'''-'-'''--'-''-''-'' <br /> -'-''-''---''--'-''-''''' ----------- ------------------------------------------------------------ '-'''--'-'-'-''-'--' <br /> 641_2;�_ <br /> /�/ /RN/\L |NSPECTON 8Y�-- �--_----. Date---��--�^---,-'-�--_--__-_. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 s""m American Street 300 West Oak Street /32 Sycamore Street o/* North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> ES-9-2 w n,~i"°a W-z/oo <br />