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APPLICATION FO. �����|T��I���� ������� Permit No <br /> ' <br /> (Complete in Duplicate) <br /> Date Issued ---- ` <br /> is hereby madeto the Son Joaquin <br /> p�:al Healthapplication is made in compliance with Co fy Ordinance No. 549. <br /> with kCo <br /> JOB ADDRESS AND CATIO ----- <br /> Owner', Name do <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel 0 Other 0 <br /> Number of living units: __� Number of bedrooms __/---- Number of baths ---/-_ Lot size -- <br /> Water Supply: Public system Community system [] Private 0 Depth to Water Table _,��ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel 0 Sandy Loam 0 Clay Loam 0 Clay E] Ad Hardpan 0 <br /> Previous, Application Made: Yes El NoK_ New Construction: <br /> ` <br /> No <br /> �TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> [No septic hank or cesspool permitted if public sower isavailable within 200 feet.) <br /> Septic 'rank: Di,+ono, from nearest �eU '~ -' <br /> Distani�e from foundation--- Material-42------ -------- <br /> ---------------- <br /> No. of comportmeo1x_��---- -Siz~^�.' '"Liq^d 6ap!k F��~� ��."-Capaci <br /> D | Field. Di�anoa from well � ' <br /> �� <br /> Number , H` of//�' ���—/_--. --'� .^.~-^=~~~.. Width= of .","cn <br /> f --------------- <br /> Type <br /> filter <br /> � ' <br /> p'' . _-' par_-n_m-__e-__u- <br /> _-- . ' o <br /> .� �_�g+_-_.- <br /> -__ _ <br /> ordinances, State laws and ul and regulations of the San Joaquin Local Health District. <br /> %oepoge Pit: Distance to nearest well '''_-- -'Distunco from foun6afioo -.-------------Distance to nearest lot line----------------- <br /> El <br /> . - <br /> _ <br /> (Signed)..........12g�Oz------ ----- �,�_ Owner and/or <br /> Alterations and/or recommendations----------- .-I <br /> [] Number of pi�-------Lining material----------------------- Diameter.__----.Dept�----_- _ceopoo|: D�+ nce from ne°�st °o}L--.--D�fonaa �omfnun6u�on----.__Lining mofe6aL--._-._ '[ Size: Diameter-------------------------------------- _---.--_-.-------..�qui6 Copux�^'_--'-_ gals. <br /> Privy: Distance from nearestw�|—'_---�'�----''--Distance from n=,ro: building------------------------------------------- <br /> 11 U��ncn +onearest lot line <br /> --------- <br /> Remodeling and/or "ypui�ng �e,c� <br /> ---'---'----------'---------'-----'--------'--'--------------'----------'-- <br /> ---'-----''--'-------'------------------- ---'--''--''---'''-------------'------------------------ <br /> --------- <br /> -----'-'''-''-'-'___'__.''-_-_'_-_-'-''-_-_----''-_-'_-.-_.'--'-''-_'__-__.| hon, DEPARTMENT USE ONLY <br /> (Plot plan, showing size 0 1 ocation of system in relation to wells, building <br /> FOR <br /> FINAL INSPECTION BY----------------------------- - -----. Date ����--------_--- _.. <br /> � ' SAN JOAQUQN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West oak Street mx Sycamore Street m* North "C" Street <br /> nto=m"". California Lodi, California Manteca, California Tracy, California <br /> sS-9--2wx°./"°a vv-2100 <br />