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---_-� - ` <br /> ruxurF1 <br /> �^ �� <br /> ^^^�^~ ^- �d��| ������� Permit �� <br /> �����U���������� ������ .. . ,[K�J'K���� <br /> ------------ <br /> (Complete in Duplicate) Date isoww6 12/24 -z-,. <br /> Issued <br /> | <br /> | <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the woric reihdescri ed. <br /> | <br /> This application is made in compliance with County Ordinance No. L ­-------------/;,�_. ,JOB ADDRESS AND LOCATI ! <br /> ------ <br /> Owner's maPhone.................................. <br /> --------''------------------------------------------------------------.................... <br /> �ont�c�o,s ----_-___'_--------.----._.--------' Phonm_-.__-------_- � <br /> |nstallation will serve: Residence �� H�� � ��m�� � Trailer C�� � M�� [] Q�, <br /> -- ' <br /> Number ofliving units: -1- Number ofbedrooms 3- Nvnn6or of baths Lot size ....�J_Z_,5-P-�[... "�s�.^'=_�-- <br /> Water Supply: Public system [] Community system [-] Private [T'—Depth ro Water Table 4P ft! � <br /> Character of m6| to a depth of 3 fwwf` Sand [] Gravel [] Sandy Loam [] Clay Loam[] Clay [] Ado6e'M~-Hmrdpun [] <br /> Previous Application Made: (|fyes,date--------------------> No [~" New Construction: Yes n�/Nn [] FH/\/VA. Yes no�~ No El ! <br /> TYPE OPINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permittedif public sewer is availa6le within 200feet.) <br /> � <br /> f ~ from - � �Se nk: � ~ � - � <br /> Di, Field: Distance from U »5�' Distancef fn � f| //q � Distancet stlot |i �- <br /> Number of <br /> Tvpo of filter m ---Dep � <br /> ' <br /> of mu+o,ioL-�J�.�!-'-Jota| |engt�--����'~-----_.--See <br /> ^ <br /> Pit' Distance ' 6 �� D��m� � nearest <br /> . .~..~.. ---_ ~.~... -__..---- <br /> W Num6arof o�o_"Z~�_..Uning mufe6u|.-�����'.-.I�e� [Xamntorx����-__D�uth-'^zr�-_._- <br /> ' Distance from neun*� well Distance from foundation Lining mu�or�|------------------------------------- <br /> El <br /> _---.--'- � <br /> `^"^"p""'' - -----'' ��------ ----- <br /> [] Size: Diameter--------------------------------------Daoth--------------------------------------------------Liquid Capacity-.______-gals. �~ | <br /> Privy Distance from nou,no well '''-'.'�--'''-'''------'Disfonce from nearest building''-''-'____.--'_-- ' <br /> [] Distance fonearest lot line----------------------------------------------------------------------- --------------_--------------------------------------- -_._.. <br /> Remodeling and/or repairing L-''-----__--------------------------------------------------------------------------------------------------- <br /> --------------------------------'--------'---'---''------'----'---'-------'----'-'---''''--'-'--'--'-----'-' ' <br /> ---'-'--.-'_-.---'-''_-__''-__----_''-_-_-__.'--__''_-__---'___'---''-'''_--.''---'-''--''-' <br /> ---------'-----------------'-------'-----'------------'--'-'-'--'-----'--'----------- <br /> ic <br /> rh U b6 rdwith SanJoaquin County <br /> o'd'"°"=ev State '"~" and rules and regulations <br /> '~~^^ D'^^'~'(8ygned).-----_---.-_-_- ---.----------__-----kOwne, mod/o, Cunfm,mtn�wy�-.-._--.--_.--_.-----.--' --'--------------^'" e»-----------'-------��� �n. ���g ,� � �� ���mn � we� ���� e� �n � �c� � reverse side). <br /> . . ' <br /> FOR DEPARTMENT USE ONLY <br /> Ft <br /> ------------------------------ <br /> ------------------------------------------------------------------------ ------ ---------------------------------------------------------------------------------- ------------------- --''--'----' <br /> _--'---'--''---'--''_''-'''_-^'''-''''-'''---''-'''-_-''''---'--'-'''---'''---''--''''-''-- <br /> -'-''-'--'--'-- '''-'-',''''-_--'''--''--'-''-'''-''_-'''---'--_.'-- <br /> F|N/\L INSPECTION ------------- Du+o-/ ------.--- <br /> S/J07AU|NLOCAL HEALTH DISTRICT <br /> 130 South American Street anoWest Oak Street 1u*Sycamore Street ummWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> �. <br />� co 9 Rcwnco 8'592wo'*2 ^r <br />