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` <br /> Date <br /> --- ---����� � [ <br /> ' indoU+he�nAhomindeocr�ad. ' <br /> ' .~.. .o the San - , <br /> This application made � ` I <br /> F 11 � r_�� � ' <br /> . _ ..____'�—�.----JOB / DDRE33ANDL[C/H { N_� — _-A� � _ <br /> Owmo/oNomn -_--.. --------- -------------------------------------------------- ' <br /> --l�l���L.�3}/�y�_�.___-------______---------__--_-'' <br /> Installation will serve: Residence 2' Al5artment House D Commercial El 'Trailer Court [3 Motel [3, Other El <br /> Number of living units: --I---- Num <br /> Water Supply: Public system El Community system 0 Friv to D' Depth to Water Table ft, <br /> Character of soil to a depth of 3 feet: Sand I-] Gravel D Sandy Loam [] Clay Loam.0 Clay ED] Iclobe ff Hardpan 0 <br /> Previous Application Made: (If yes,clate--------------------) No New Construction. Yes D No D FHA/VA. Yes I-] <br /> No <br /> TYPE OF INSTALLATION AND SPECIFI CATIONS. t <br /> INci septic fank.or cesspool pormitted if public sewer is available with,in 1 200 feet.) <br /> WO-1 �, "4 1 <br /> Disposal ield- Distance from nearestw611-1`�.........Distance)from foundation----Z.9-----------Distance to nea <br /> 01 Disfanci� to hearest lot <br />. �--- <br /> I here�6y certify fzt I have prepared this application and that the work will be done in accordance with San Jo quin Coun y <br /> ordinances, State laws, and rules aitcl: regulations of the San Joaquin Local Health District. <br /> (Sirg'~�, -----'' <br /> ---------- L --------- --------------------------- ----------------------- <br /> (Plotpl can be placed on reverse side). <br /> an, showing siz67 f 10 oc tio'n 0 system in relation to wells, buildings, etc., <br /> FOR DEPARTMENT USE ONLY <br /> xE'/c,vED n,------------------------ ------------------------__.y^_v`, --------- -------------------------------------------- D ° _ <br /> � <br /> '�-''-' D�TE'''-'__.-_.___-'-_________8U|LD|NGPERMIT ISSUED-_-.'''.- -_.''--'-_''--_---''-_-'---' ---.- <br /> AKm,a�uno-and/or rnoJmmen6 ---_-----`_--_.- _--__'_.__'-_-_-_--'----_-._-__ <br /> '-'------'''-''--''--''''----'---''-' <br /> _._.__________._._'-' L--''''-''''-''''--'---'---'--- <br /> —'--'-'—''-'''- -------------------- -----'''--''-'-''-----------------------------------------------------------------------------_-'''---'''---'---_.- <br /> / <br /> ---'-'-'--'-'''---'-----T''-'---'''--''''-''-_'''-----'--''-_.'-'-'-''-''-_'-'''-- ' ---------------------------- <br /> ------------ <br /> -------------------- <br /> '_---'-'- <br /> � <br /> '''-- <br /> --'--'-' ------''----�� <br /> .-'--'_-------------------------------------------------------------------------- ----''- <br /> ''_''^--''-' <br /> HN/ L INSPECTION' <br /> =4--------------------------------------- Do�o --------'----_._-__ <br /> SANJOAQU|NLOCALHEALTHDISTRKCT <br /> |� <br /> ' <br /> � <br /> 130 South American Street 300 West Oak Street 124 Sycaim are Street 205 Wait 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California � <br /> / <br /> "".""°"°="."°"""=.2M 6-60 <br />