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��[����� F�� ������� ���� ��� N� <br /> �r U � Duplicate) � <br /> ` `--''-- ` Doha Issued _'l����1uL. <br /> ��|���� is hereby to theSan JoaquinLocal HealthD����kr u permit �c��� and �m�Ut�.o� herein described.TKiapplication is madein compliancewith <br /> _ County No. 549 <br /> � �OADDRESS � 4� �������'�������'�'�����'�'�Owners Nome-_ � - ----------- <br /> Phone--_-'----_--. ' <br /> A66 ' '__.--�-''--''-__-_ <br /> Con+ractor, Name'' - -----' ''''-'-'''--''''--''''-'------'-' Phone----------------------_'''-- <br /> |nstaUation will serve: Residence g�`ApartmenfHouse E] Commercial El Trailer Court E] Motel F] Other [] <br /> Number <br /> 'of living units: -x/- Number of bedrooms -An Number of baths ��.. Lot size ~ ----------------- <br /> ~__-- <br /> Water Supply: Public oyoham �� Cn�mun�y �y��m [] Pr�ufe �4,~D�ot hz \�utorTu6� ���'fL <br /> Character of soil to depth of foot: Sand [] Gravel [� 5un6y Loum [� C|uy Loum [] C|ay [� �6o6�W�~-Handpun F .C� <br /> Previous Application Made: Yo, [] No @�" New Construction: Yes [l No j?- FHA/VA. Yes El NuW�— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No yopfim tank or cesspool ponn|fhod if public sewer isavailable within 200 feet.) <br /> � <br /> Sept* Tank: Distance from nearest well----------------- from foundation--------------------Material------------------------------------------------- <br /> No. ofcvmpur�n�nt,------_-.S�e-__.-._-_.--Uquid 6o�h-_---.--.Copodt�.-------. <br /> -`�-~- <br /> Di Distance from nearest well ,f_9-- from foum6 <br /> Num6or of | �� ot of � | '���� ' Wi�+� of ch <br /> -�~- ` � �-------- <br /> Type nf filter m |�-� ° - -.. � � <br /> Seepage Pit: Distance to neorn,+ w�L '- ion-J� to nearest lot line_ <br /> 4?~ <br /> - <br /> Number of pO�-���----Uninq mo+e6oL Size: D|ume+ac���~�.,.-Dept h- --'-- <br /> Cvsspu^ ` Distance from nearest well----------------- from foundation-------------- Lining material -.-----_--__ <br /> [] Size: Diameter_''''--'''-,''-_Deof�.'-'''''-_.'''''_-'''_-Uq�d Copndf�'--'--�-'_-g°b. <br /> Privy. Distance from nva,e� °eL''-''''-'-'--'''--_-Distance from nearest building''����-��-''-''-'- \ <br /> [] Distance to noon,,+ |o+ line` --'__-.___-------_-_----- ' <br /> Q <br /> Remodeling and/or repairing (describe):------- -------- <br /> 1110141 <br /> ---'__-__.._____.__._._.. <br /> ---___'-''___'-'_-.-_'--__'''-_.'-'--_-'___'--_--___'''-_-'----_.-'---'''_-.'__-'-'-''_-.'- <br /> ------''-''------'--'--''------------'-''--'----'''--''------'----'----'------'---'---- <br /> � --------------------------------- --'---''�--''------.'-----------''--------------'-----'--------''''-----.''-----'---------''------'-------'---------'------.------'�'--------'--------'--- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance5. State laws, 9rd rules and recplations; of the San Joaquin L cal Health District. <br /> (Plot plan, showing size of lo cation of system in relation to wells, buildings. etc., can be placed on reverse side). <br /> palon 0 <br /> FOR DEPARTMENT USE ONLY <br /> -----------------------------------I--------------------1-1---------------------- -- -- --0------------- <br /> -------------------- ----------------------------------------------------------------------------------------------------------------------------------------- ......------------------------------------------------------- <br /> ----_-._-_---------_-'___---_--_----_-_-----_--_---_._---._-._-._--_-_ ) <br /> -''----'��''-''''�--''---''-_''''_'''--' --------- ----------------- ------------------------------------------- '--�'---''-_' / <br /> � �� �� - � <br /> m <br /> FINAL INSPECTION 8Y�'_- �'- 0ut�.-''� -' -'-''''_'-'''-�'�-'''-'' <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /oo nvmh Am°a"°" s*=°v 3mnWest Oak St=.* /oz sv"°m"= $=°+ 8/4 m°+h "C" Street <br /> Woca+"". c"la","/° Lodi, California Manteca, California Tracy, California <br /> ss--v-�w ' m�.u"o i��r r�p�cp. <br />. <br />�� ' <br />