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8r/ XO/«' ^- / ~ oo <br />�---' � � �� ��� ��� �� ���� ��RN� <br /> (Complete in uwp/icmre) Date issued --- <br /> ------------ <br /> �/�.����'u�---� <br /> � -­---------- <br /> lication is hereby made to the San Joaquin Local Health D���1� u permit toom��o� |m�||the�� herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549' <br /> JOB ADDRESS �N -x----...--.------'-----'-._--------'''-- <br /> In <br /> ^ Phone _______. <br /> C}wnars Num�._ _���_--___._-__----.----_-_.--.. --__-.. <br /> -------------_---------- <br /> Address-------------_--------- ----'--------------------------------------------------------'------------------ ------------------------------------- <br /> --'-----''-- <br /> �� Phpne----------------------------------- <br /> Contractor's <br /> Nmme' ...+'�'°^�.�-.-----_-------------.------------ <br /> Insta|iation will serve. Residence [-] Apartment House [] Commercial [:] Trailer Court El Motel [] Other a- <br /> Number of living units- --- Number ofbedrooms -------- Number of baths 1 Lot size -- Q16.*'. I u70'----'---'-' <br /> Water Supply: Public systemEl Community system Private 09-tepth To Water � L,.e ft. <br />| C6mny�ermfsoil to w depth of 0ww+: Sand [] Gravel [] Sandy Loam [] Clay Loam [] Clay [] Adobm2�'�HanJpmn <br /> Previous Application kAwdm: (If yeo,cloto--------------------) No e New Construction: Yes ET'�No D FHA/VA. Yes [] No <br />� TYPE OF INSTALLATION AND SPECIFICATIONS: ~^ <br /> i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> / <br />' ure,� wm/� -- vu.onu, .." foundation--" �A <br /> Septic� �"nk' Distance from no /^' --`~-"p--"-"-''-�'-'n�------- <br /> =- <br /> '�� �\� �� �o id 6 ot�'~n~-.----''Nn. ofonmpn�ment»--.-- ---Gze-. .] --_.. <br /> _­ <br /> Disposal Field: Distance from nearest n_,� / Distance from `o","""" .~'~.^^. to nearest _ --15_-- �. <br /> Iinby g+ c� � / ��� ""/d' of trench —~ | <br />� Soopoge p�� Distance to nearest weli �o�.............Distance D��n -fnz~m foundation./ ^ '----Distance to nearest lot Uno' �� <br /> -'... <br /> ^-'Sba� Diameter ,��� '^ -Deot6- �-4~5=�._-- <br /> E" Num6erofp�,'.�I','-'''_Uning mu+o�oi'� °-� ' <br /> Cesspool: Distance from n'eoro, well-------------Didanc= from foundation------------------- Uing material . - <br /> ] Size: Diameter-------------------------- -----------Do.ufk ' Liquid �"p~^ / '� - _9us. <br />' Privy- Distance from nearest well .Distmnce from nearest building ------------------------------------ <br /> 0 <br /> ' <br /> -----.---- <br /> ] ~» <br /> Distance �� |�o'''—'''--'�-''''---''_---'_---__.-__.'---_.'''-'------_-- <br />| <br />� Remo6elimJ and/or repairing (6o,crbe):--------- -------------------------------------- --------------------------------------------------------------...................... .-_'--' <br /> ----''-___-____---'_-__--_____--.__-__._'--____--___..-___._-_---_'------__-- <br /> ._--_--'.__----__----_—___.__-__..-_-'--''-__.--__----_.---_--_-_-'_-'-'--'------ <br /> | her cart fy th __ -have_-'__.___-_--__---'''___-__'''__.__.'__.--'-_.'_--_'----''-'-----'-- <br /> --'---------'--'' h k willbdone in ,6with San Joaquin County <br /> ordinances, State laws, and rules and regulaltions of t Sa loaqu;,n Local Health District. <br /> ~ <br /> (Plot plan, showing size of lot, locafioQn �40 n*reliation to ells, buildings, efc., can be placed on revers <br /> FOR DEPARTMENT USE ONLY <br /> � . <br /> mEv}Evvuu BY <br /> Alterations and/or r <br /> --' .____ � __________________�______���/.___________ ��___.__.____.__.__ --.. <br /> _________________________________________________'__________________ <br /> y -'----''—'-'-_''-----''-'-''''_-._' <br /> � .---_''''—''--------- <br /> FINAL INSPECTION BY Date--- -------- <br /> ��N J���U|N LOCAL HEALTH �|�T��T <br /> ' <br /> 130 South American Street awnWest Oak Street ,o*Sycarn"mStreet 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 ncv/oEo o'=p eu 5'*2 ATLAS <br />