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| �~� <br />R�R{�F|CEUSG K � <br />_ ........ ­ --------------- <br />(Complete in Duplicate) <br />. .............. This Permit Exeires- I Year From Date Issu <br />0 f <br />Application is hereby made to the San Joaquin Local Healfh District for a permit tosc kfin fork erein describe <br />This application is made in compliance with County Ordinance No, 549. 1 d. <br />Installation will serve: <br />I Residence El Apartment House E] Commercial El Trailer Court 0 Motel C] other <br />Number of living units: ........ Number of bedrooms ........ Number of baths -------- Lot size ....... <br />Water Supply: Public system Ej Community system El Private J4 Depth to Wafer TableigP. ft. <br />Charicterof uAlto a depth of 3 feet: Sando Gravel[] Sandy.Loaml-] ClayLoamE] Clay[] Adobe[] Hardpano <br />� ..rT wr 11431ALLA/xOm AND ; <br />' | (Nomept icmenko* cesspool permitted ifpublic tower is availa ble within .200 feet.) <br />SRptic Tank: Distance from nearest well ... W,17'_Distance from foundafion__14�-!��.Ivlaterial ----- <br />� -- �r of compartments'-'~- '^�-'�9«� unR! _��*�^c_'Cw <br />Disposal Field: ���nco�� ~*U ,����rDance ' / <br />Number of lines ------------ Length of 'each line. ------- of french..X_C...tf;r <br />Type of filter of filfer material-ARA-Z.-K ...... Total length ....... 10.0 -�� <br />Seepage Pit: Distance to nearest well... --------------_ ...Distance from 'foundation ------------------- Distance to nearest lot line- <br />I hereby certify that I have prepared this application and that fh; work will be done in accordance with San Joaquin County <br />I ordinances. State laws, and rules and regulations of.the S Joaquin Local Health District. <br />Signed) ........ C1.7 <br />m in relation to wells, buildings, etc., can be placed an reverse side). <br />A. FOR DEPARTMENT USE ONLY.' <br />------_-_-__----_--.---- nearest lot linehv.t2�.. <br />. <br />------___----_�---''------'---''_-___-_----__^-' <br />_-_---''_-'-'---_-----'-_---'_-_-��'--_-_-.--_--_'-----_--_-_'--------_'-'-- <br />^'~ --' <br />_.-.---'-'----'---'-/- <br />--------------------------------------------------------- <br />''_- <br />--------------------------------------- ................... <br />FINAL |NSP "nnn----�F-��'-' ...........f ----------------------------------- <br />SAN <br />---------'SAN ' <br />�����U�N ����LFf��L%�f�/���|�� / <br />| <br />130 South American Street 300 West Oak Street /o^Sycamore ��°/ uosWest p,h Street <br />/ <br />Stockton, uw�m <br />^" Lodi, California ww"te+",m/w","/" m=»California <br />,�" <br />°",."c" °.", °" "'".=`^° <br />� <br />h �� <br />