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<br /> gr APPLICATIOW FfJPPoriyO' No,
<br /> ,..
<br /> 'ell
<br /> (Oer,;pfete in Gfuflirva�$) ��a-
<br /> Applicoiion is hereby Matte 10 the San Joaquin Locdl Healfh District for a-pormlf to construct arid insfall the work here;h de .•ribed.
<br /> This applicofW is made In compliance inrifh County 04'nance No, SSS, / /r
<br /> JOB ADDRESS AND LOCATION_..... ,....................
<br /> OYinQFS f`teats................ ------- ,-a rk• ...--'.................................................................... Phone...............
<br /> AddraS$....... .... ... '
<br /> -- ---- � --- ..."...... .. ` T
<br /> ..,,--o•----•--_,., ...................................... . ...--'--._.__.
<br /> Contractor's Bame----- - } ..-. Pfoe, � ..........,,_...._• 7
<br /> Installation will serval Residence x
<br /> �Apnrtment House Commercial ❑ Trailer Court Lj- Motel p Ofhor ❑
<br /> Number of living units. ,• Numbor of badroornsr, _.- Number 0f baths ___/___ Lot size .......I J...._f ,:......,(.-_.._-
<br /> Wnfer Supply: Public system ❑ Commuriify systom ❑ Private ') Depth to Water Tctble . ff.
<br /> Charactor of soil to a depth of 3 feet: Sand [] Gravel [j sandy LoarnV Clay Loom El. Clay ❑ Adob Hardpan ElPrevious Applicaflon Made: Yes n No/k New Construcfion. Yes [j No ( . .I`F-A/VA: Yes ❑ No 1
<br /> C
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' .�
<br /> (No septic tank or'cesspool permitted if public sewerds availa6la s"KIn 200 fee},)
<br /> S0Pf,;C,f,6hk, Distance from nearesf well. d..' Distance from ound fi0n..__r'Q Materi --- 1 ,t� � �
<br /> 1,40. of cbmport--nents......0..----_•-••---:Size... i'f.�, �-Liyuid depth..- A/ _Ca un
<br /> • f city,. .� ,....
<br /> Di5poVI l-iald:• Distance from nearest we11-4�L-------.Distance from foundation.., C .....- Distance to nearest lot (inti.,., .......
<br /> ` Number of lines.._......./.......................Lengih-of each line_....7-Q_--�--..,_,...Width pf trench........7..F/. .��._....,...._
<br /> Type of filter material__,,, zQ.0�-_Dopth o filter maters ' '�
<br /> " Yp •• � �)- t I-... _.a$s.........,Total tang h_,.;t ._.� � •'••-----•---••---"�
<br /> Seepago Pit: Distance'fo nearest well....------- Disfance`rrorn foundation_.L..,.:..'1:...._Distance to nearest lot line_..............
<br /> El Numb©t ofpits---••- L�ninyrna#c�na I--.-"---s------- --• c,it`
<br /> e: Dlamet r............I'll.......Depth.................................
<br /> Cesspool: Distance from "nearest Wei(.......,.,.......Distance from foundation.....__,,,•........Lining material_........ ......................... r
<br /> (� Depth
<br /> • Size: Drarnefer.......................•---._......... .-•-..........--•,•.................,.. Liquid Capacity �
<br /> Privy: Distance from nearest we . ......_........•................ m uildin... .. . t
<br /> Q
<br /> Distance
<br /> to nearer� Iuf line_........................................:......•----•--....:>�
<br /> . • •
<br /> ------._................---------
<br /> - . _,
<br /> -aow.a T�t. ,.,
<br /> Remodeling ons{/or repairing (doscril�a):................................I..............................._....._.,,.....� ................................. � - •-.•_� _
<br /> .............
<br /> .-•.................... ............,,----.............•....................•--.,-.,,_.,.,••-•-•----------.,,'---•..................:.1-------•...................................
<br /> hereby certify that I have prepared this opplicstlon and that the work w111 be done in accordance with San Jooquin County
<br /> ordinancos, State laws, and rules end re9ulafion5,of4fhe=Sen Jooquin Local Health Districf,
<br /> (Signed) _
<br /> .............m -�--- '".... ..----?jA -- ..,..... . ., - ..,V.._.:----..__._...........(Owner and/or Cont(oclar)
<br /> Y
<br /> ...........I..................................... ...(Tit(e'.__._
<br /> B ::................ ... r.......�:. -,.,,.,..-----------,. .. ._... �.cY_i,N..J.fir.��..,..,.-----
<br /> (Plot pion, showing sire of lot, location of system in relation to wells, buildings, efc., can be placed on.�.,reverse side).
<br /> FOR DEPARTMENT USE ONLY^
<br /> APPLICATION ACCEPTED BY- _ -
<br /> . ........•..................................•---••--•-........-•--•--•-• RATE,------ ._......�.,......_,....�,..----........._._.
<br /> REVIEWEDBY....,:. -•.........................................•...............................•---------..__.. DA7E- ............-•--.............'
<br /> BUILDING PERMIT ISSUED....................
<br /> .......................•------............—.-------...........---•---------.,.... DATE---.........
<br /> ................
<br /> Alterafions and/or racommendafionss...................................................................................... -----•........... l..._....
<br /> _.............•------------....................---'-•----.....,..,..._...........,........,..----------- ........—........................--......,...._..........,.......--'---..............................................
<br /> ..............................•- --,.........................._.....................................................................................
<br /> .............-------'...............,...................,
<br /> ...-----.- __............ ,-._.................... ..................:.... - --......................... ......._.......
<br /> BYFiNAL INSPE .
<br /> .., Date...._..
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 South Amorioen Shoef 300 West 0A SFraof 132 Sycarnoro Street 014 North "C" Sirgel
<br /> Stockton, Callfornla Loall, California Pslenteca, California Tracy, Callfornio
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