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i-v —tj— goila, or cve:Ipooj purmauea IT pumic sewer is avaname wornin '4uV teet.j <br /> Septic T k.- Disf'e from nearest well-- -- -----------Distance fr'o*"Ifoundaf;on-- -----------------Material--- ------ ------- <br /> fr�� No. ur compartments----- ... ---------Size.. <br /> -------------------------..__Liquid depth . Capa <br /> Disposal Field: Distance from nearest v/e�ll /0-0, <br /> -------Distance from foundatiZ-rz'�---------Distance- - - <br /> to <br /> Ltd Number of lines--------/�Y' Length of each line._-. <br /> .--__...-.-...Width of trench_-_. <br /> Type of filter materia ------Depth of filter material----te---- - --.--.Total length-.-.'..4- <br /> _ Seepag fpi Distance <br /> ength----'L4- <br /> Distance to nearest well--- -------------- - -Distance from foundation-------------------Distance to nearest <br /> Number of pits--------------------Lining material-...-_--------- ------Size: Diameter_-.-.---------_..._.Depth-. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation- - --------------Lining material-__._. <br /> El Size: Diameter- ------- ----------------- -------Depth-------`----------------------------- ..Liquid Capacity--- <br /> Privy: <br /> apacity.....Privy: Distance from nearest well--.._._._.-._.-_-__.._-------------_--- Distance from nearest building ---- ------ <br /> ❑ <br /> Distance to nearest lot line-- ----------------------------------- ------- <br /> ----------- ------- ----- --------------------------- <br /> Remodeling and/or repairing (describe):- ----- ------- <br /> --------------------------- <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 <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------ ------ 9 --f <br /> -,-7-t-1 ....... ---- --- -------(3?�Yner an <br /> By:---------- :t - ----------- -------- ----- ---------------------------------------(Tif le).... <br /> -------------------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sic1c <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ---------- -----------;........ ------------------------------ DATE------------- <br /> S <br /> REVIEWED BY.. -------- ------ <br /> -------------------- ---------- ------ DATE---------- <br /> BUILDING PERMIT ISSUED------------------ -------------------------- ------------------------ DATE--------- ---------------- <br /> ---------------- <br /> -- <br /> Alterations and/or recommendations:--------- - --------------------- <br /> -------------------------------------------------------- ------------ --------------------- --------------------------------------I- ------------- ---------------- ...... <br /> ------------ --------------------------------------------------- ---------- ---------- ---------- ---------------- ----------------------- ------ ----------- ----------------------- ---- <br /> ---------------- ------------------------ -------------------- ---------------------------------------------------------- ------------ --------- -------- ----------------- <br /> --------------------------------- ---- —------------ ------- <br /> - --- -- ----- <br /> ----------;------- ------------------------ -------------------- ---- ---- ----------- <br /> A, <br /> K <br /> --- --------- --------- <br /> FINAL INSPECTION BY:.----------- ----------- -----—------------ --------------- Date <br /> SANJOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North <br /> Stockton, California Lodi, California Manteca, California Tracy, C, <br /> ES-9-2M 10-52 Revised W-2100 <br />