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' <br /> 3r 4— <br /> /y - <br /> Application is hereby mhacle to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ------- <br /> Owner's Name------------- -----''''--'--'------''-' <br /> '== <br /> Installation will serve: Residence Apartment House [] Commercial F] Trailer Court [3 Motel Ej Other <br /> Number of living units. ­�Km'umber of bedrooms 7--. Number of baths ...L Lot size ...... ................ <br /> Water Supply: Public system E] Community system E] Privateg Depth to Water Table !,/Zo ft. <br />' Character of sail to a depth _- ^~ Gravel ^~ Sandy_ -_' ^~ _-' -__ ^^ --' °] Adobe Hardpan C] <br /> Previous Application Made: Ufyes,date.--------------------) No New Construction: Yes [] No [] FHA/VA. Ye* [] No [] <br />_ <br /> TYPE OF INSTALLATION AN0 - ` ��: /\ <br /> --'. -- � <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well .-__..-Distance from 6aun6o . -'_--_`]Mote,iaL-..-.--_---..__.—.___. <br /> � No. of compartments.-------------------------Size--------------------------------Liquid dmo+ -----------------------^Capacity................... <br /> ' ............ <br /> Disposal- Distance from <br /> ���3�«�4- �0 ��-6*, �� |�nos / Lmngt _of �a66 |i of t�nck' / '............... <br /> / ( � <br /> ^-' -` Tvoo ol-filter mat | 'Deofh 0`f filter mutohui' -.--.--Total -----. � <br /> ") <br /> Seepage Pit: Distance to nearest well ------------Distance from foundation...................Distance !o nearest lot line................. �. <br /> [] Number ofpits_.--,_--Un|mJ mm+n�uL_-'''''-'S�e: Diameter---_----------------- <br /> . 4 <br /> cesspool: Distance from noura, welL.__--_Distance from 6pdu�on---.^------ Lining mu+er�L—''_._-_''-__ <br /> [] <br /> Size. [�omator--''�_'--'-�'-''-Dvot�''-�_-_..n''---'''''�-_.L�uid -__-_-. <br /> gals, <br /> Privy: Distance from nearest well '''--'''__.-_.-_''_---Distance fnofn nearest 6uUcling_--_.''--------' � V <br />/ 0 Distance to nearest lot line--------------------------------------------------------------------' - <br /> / <br /> � .-�---`^-+-._—^Remodeling and/or repairing <br /> �^^~^^'~^^�- __-_-__---______--^-.-_-'---_._.____'----_-'_----' <br /> ------------------ ---' -------------------- ------ <br /> ------------------------------..........------------------------------------------------------------------------------------------' <br /> I hereby 'certify that I havp i.! a I - <br /> _0:apared fhi pplication.and that the work will be done in accordance with San Joaquin County <br /> "'""a"°ev <br /> \»/gnm��_z�_^�,� �� _~e��_ -- and/or Contractor) <br /> BY: <br /> (Plot plan. showing size of lot, locaflon of system in relation to wells, buildings, etc., cin be placed on reverse side). <br /> FOP.DEPARTI,�W_USE ONLY <br /> xrruCAnuN ACCEPTED' o/------"--------------------- -------------- -- -----------------------------------._.. uA|e-----1- 2_�-_r_���.����-^_____ <br /> REVIEWED BY-----__.__._--��--_._-----.-__.-__.-___--- DATE_--'-.__..--_----_____. <br /> 0U|U0NG PERMIT ISSUED - ^ D�� � <br /> ___----.�-'_'---_ .____- _----.___-----__--' <br /> AMerm�mnumn6/mr nwpx,nmwnda�on*;-.------------'----..-.------------------------------------------------------------------_--.------_-. <br /> / <br /> *° <br /> -------------- -------- <br /> - ' <br /> � HN/\L INSPECTION BY:----- ���{��'��,��.���`/�/�e�n' 4,te---------------------------------___--------------------------------^_ <br /> SAN JOAQU/N LOCAL HEALTH DISTRICT <br /> 13nSouth American Street 3vpWest Oak Street 1o*Sycamore Street m0mWest 9th Street <br /> Stockton,California Lodi,California ma",°"m'California rra"v'California . <br /> = " REVISED °'"° w" r"/ ATLAS <br />