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� � � � �� R��N��_�.�� .�_ �� '- V~ ^* (Complete in Dwolica+o/ � Doh, |omeJ��.��.��r��r` / lication is ny6v made to the San Joaquin Local Health District for and install the work herein described.. T is application is made in compliance with County Ordinance No. 549. � JOB ADDRESS AND LDC N- �J� .��.��x��'��.- �..JL..~.— . Owner's Name --'��'��°6�6*,--'�I��.l�'"'&�-------- -------------------------------------------------------------------- -m---- Phone .-.----------------_—.-----' ' A6dnss -----y �1�� ~� —.----_-----_-------.--_.v---_—..------_.-----_— Contractor'N D W Ph Installation will serve: ResidenceIC Apartment House [] Commercial E] Trailer Court E] Motel E] Other E] Wafer Supply: Publi' system E] Community system F c Private D( Depth to Water Table -------- ff, Character of soil to a depth of 3 feet: Sand Gravel [] Sandy Loam 0 Clay Loam E] Clay E] 'Adobe Hardpan El Previous Application Made: Yes E] No A- New Construction: Yes,% No ` (No septic. permitted if public sewer is available within 200 feet.) , Septic nx' Ds� � ,m �� °e./ �� ^ u,� mm � o ` �� Material ��. Number of xn;` of each one__Op Width�Widthorfrench w^ Type of filter maferiaI.JY-,_-VPV-_�Depfh of filter materia ; Seepage Pit Distance to nearest well from foundation [l Number of pits ---------------------- Lining i | Size: O Dept h Co,,pvn|: Distance from no*'ro,twell ----------------- Distance from foundation -------------------- Lining material —.—_.---.---^--- [] . Size: Diameter -------------------------------------- ----------------------------------------------------- Liquid Cupacky_—__._—'-/]o|s. �� Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building —_---__'__.'_-_-- [] Distance to nearest |o+ line ----------------------------------------------------------------------------------------------------------------------------------------------- � .^ Remodeling and/o, repairing �''-'—J�. '_—��_,jJ_j_ --------------------------------------------------- ___-__—_--_' --'___.--__.—_____.___..____.---_—_—_--___.._____' U ��------------_--_-------------------'---''------------------------------------------------------------------'-----------'--- --'--------------------'--- '—'—'-------'-------'--''----------'----'--'----------'---�------'--'--'-----'----'' | ' County ordinances, �trfe laws, and rules and �egulafions of the San Joaquin Local Health District. By: --------------------------------------------------------------------------------------- ------------------------------------------------ /le) ----�_—________.____ *i� (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc..can 6eplaced on reverse side). FOR DEPARTMENT USE ON LY � ( � �� ApPUCATDN ACCEPTED &Y'_.'- �\�L ------------ -------------------------- DATE'''-t� ------------- REVIEWED —'—' RB/|EVVB] BY -------------------------------- ------->�--��--'��—.---------_—'_—..___---_— DAJE--'----__------.___.,--_.___ DU|LD|NG PERMIT ISSUED ---------------------------------------------------------------- ------------------------ -------------- DATE --------------------------------------------------- __�_ Alterations and/or recommendations: ------ ------------------------------ -------------------------------------------------------------------------------------------------------------- ---------- . . '—'--'—'''--'''_—''—'''--.�'''—�---------�-------------------- '—''—'--''--''''---''—''''_—.'''_-''�'—'—''_—'_'-''''—''''---'''''—_—'.-�---'''—''''-__.--'--''/ j. �� FINAL INSPECTION BY:_ ��`��' "!.�.��//��./ Dn+r ^� ,� �� ~ —�� — ----']r' ''J'---'---'---� 6AN JOAQU|N LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street ` 132 Sycamore Street 814 North "C" Street ES -9-2M B-51 Revlsec� W-2100