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� <br /> APPLICATION FOR ������ ��� ��� N� ��.��_ <br /> ° 0 . �� <br /> � m <br /> V ' rC~^r~'~ in Duplicate) <br /> Date |,mue6 ' <br /> ` <br /> 'is hereby made to the San Joaquin Local Health Di���f�o ��� �c��� and ��|| �e*o� ��n described. <br /> application is made in compliance with County Ordinance No. 549. ' <br /> �-/� <br /> JOB ADDRESSAND - ��.� --...x -I--�`- [ <br /> Owner's Name------------- -..z--- -9 ------- ------ Phone_ ra'e�.��x'..s��'� <br /> � � <br /> A66�^�------.______ .4�.��_.. � ___._���i________________.___._____._.. <br /> Contractor's Name------ ---------------------- ------------------------------ ____.___.. Phone___.__..____ <br /> - <br /> hnstallation will serve: Residence � /��� H�� � Commercial ��� �� � d� �� <br /> -- -- <br /> Number ofliving units: ---L Number ofbedrooms &- Number ofbaths I-. Lot size <br /> Water Supply: Public system El Community system � Priva+e)Ej Depth to Water Table /e--- ft. <br /> Character of soil to a depth of feet; Sand Gravel El Sandy LoamC< Clay Loam [] Clay [] Adobe[] Hardpan [] <br /> Previous Application Mode: Yes [], NoNew Construction: Yes)< No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic funk or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: O�,+oncn from nearest �� . z�~��..... D|,+o f - <br /> ion .-/'/7._'Wu+�ri*L.������ <br /> U <br /> No. ofconopu�nnenh-.---��----Size-«� K n_4XX--Liqui6 <br /> 6op!fh--------------------- <br /> Copo6fy--.4� �w�~.-''- <br /> . <br /> D|^r`~| Field: Distance from neum,+ wr|| � 'Dis+anco from foundation 'x/�� '�Di�onca to nearest lot line------ <br /> Number Length of each of trench 2 � <br /> Tvpe of filter matorioL� G _DepH` of fi|+e, muforiuL- �� --7o+o| . <br /> length---.-..��.����_-_- <br /> e Pit: Distance to nearest well -_---------------Distance from foundation.-_--.---Distance to nearest lot line---- -_-- Pv <br /> [� Num6aroJp|ts'-''-'''-Un|ng material_''---',,'Size: Diameter--------------- ------Depth---------- --------------------- »-tA <br /> ' <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------- -----------Lining mufe,iaL-''-'-'-'-'''- (� <br /> [] Size: Diameter-------------------------------------- ----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy Distance from nearest well-------------------------------------------------Distance from nearest building.'--'''_-__'-------- / <br /> [] Distance to noonax+ lot |ine..::----Irl .-�-----_-_.--__.._-_-__-__-.-_._----.---.--- - <br /> Rvmo6elingu"6/or repairing (6naribe):'''_-''-'-''--''--'-...... --------------------------------------------- -------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ <br /> -------------------------------------------- '--'------------------'------'-----''--'--------------'-----------------' <br /> ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I <br /> - <br /> have prepared this application and fhafthe work will be done in ammo,6anum with San Joaquin County <br /> ordinances. Sf* lamo, Opt rules and regulations of the San Joaquin Local Health District. <br /> <SignodL/-���������...N������x L--------.----.---.------_-------(Owner and/or Contractor) � <br /> By:.......... ___-__-' ----------------------------------------------------------------------------------------------ri+le) --------_--_---'----. <br /> (Plot plan. showing size of lot, location of system in relafion to wells, buildings, etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> BUILDINGPERMIT ISSUED-------------------W- ----11-----------------------------------------------------I--- DATE------------_---------- ----------------------------------- <br /> Alte,mtyonu and/or recommendations:---------------------------------------------------------------------...... -------------------------------------------------------------------------------- <br /> -------------------- ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ <br /> ----------'''-'--'_-''''---'''-''.-'''''_-.---'''-''----'-'''-''''--'--''--'-'- -------------- ----------''-------- --------- <br /> - . <br /> --''__'--'-----''---'---''''--''''-'''-_''---'---'-__'-_'''_-'--.'--''''---_.''---'''-'__-'''--' <br /> --_.-._-- ---------------- <br /> _~� * <br /> RN/\L INSPECTION BY --. Du+o-'.������,������.�X------.-_._-' � <br /> � <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> on South Am*n**" Street 300 West Oak Street mz Sycamore Street m+ N*rfh ^C^ Street <br /> Stockton, California 4,a|, California k4°n*m"°, California Tracy, California <br />