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� <br /> ������h�� ��� ������T �� ������ Pem� No. -'�����' <br /> ' <br /> (Complete in Duplicate) <br /> Date Issued ------ <br /> Application is hereby <br /> ^ <br /> mm6n to the Son Joaquin Local Health District for o permit to construct and install the work herein described. \ <br /> This application is made in compliance with County Ordinance No. 549. _` [ <br />' <br /> -JOB ADDRESS AND LOCATION --- -- - . ---------------------------------------- <br /> Owner's Name--------------5 -'—___._ <br /> -----------''' --------------------------------------- <br /> Contractor's <br /> ------'' <br /> Con+mc+o/sName <br /> l <br /> Num�.-._��^-��._,-. <br /> |msfailation ,ill serve: Residence Commercial [] Trailer Court [_1 Motel Other E] <br /> /number �� �' <br /> Number ofliving un��� �-x- mumbn, of bedrooms Number o� 6o+h, .,^-. Lot size .�� ---- <br /> Water Supply: Public systemkCommunify system [I Private � Depth to Water Table !�e6, ff. <br /> Character of muU to a depth of feet- Sand [] Gravel Sandy Loam El Clay Loom 0 Clay ElAdb 'Hu,JPon [] <br /> Previous Application k4u6m: Yes [] No ���� New Construction: YesE] No r�° FHA/V/\. Yas [] No]�[ � <br /> �� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No s7fic tank o,wessppm| permitted if public sewer is available w|fh|m 200 feet.) , <br /> Septlic an Distance from nearest well ..Distance from foundation � te i | �� - -------- <br /> '_-' <br /> ----------- <br /> No. <br /> ---No. 1 <br /> ofcwmpo�m�nt�----.---..3��_.'--,'�--__�qui6 6�R��-'_-----'�apod��.__—_- � <br /> D�i�sptb)siell Distance from nearest well---4/0-r4C.bisfance from Distance to^ lot . <br /> - ------------- <br /> Type of filter material� / <br /> S1 epa, <br /> Distance to near t ;de__-Disfance'from foundation---- -------------rDisfance to nearest lot line----------------- <br /> 4Number of material ' � <br /> \ <br /> Cesspool: Distance fn»mneure, 'woH'��'.`'-Distance from foundation--------------------Lining material_-''-'-'-''-''- <br /> El Size: Diameter.---'__.---.._Dn��-_-._--__-�___--_Uquid Capacity-.--------------------------` . �~ / <br /> Privy; Distance from nearest well.-----------------------------------------------Dis+ nce from nearest building------------------------------------------ <br /> L1 Distance to nearest �"f line-------- _' ------------------------------------------------- --.- <br /> ' <br /> . <br /> Rempd��g on6/�, n�p�i�ng n�sc����� 4 ' <br /> --'---'-- '-----' '' -- ---' --------------- - <br /> ___._ __�� _ _ ,-------------- <br /> --------------------------------- <br /> '_ <br /> -----------_------_--_---_---_--_---_'__-. --------------------------------- <br /> red this application and that the accordance with San Joaquin County .! <br /> ordinances, Sfat6Aa�!Y10d rules and-reaulations of.jhe San Joaquin Local Health District. <br /> p`/gnoo� ^ ^°�' . ��� � �~~~��� ��~- c'"'| <br /> By: [ ' <br /> (Plot plan, showing size of lot, location of system in relation to <br /> b i ings, efc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 8U|LD|NG PERMIT ISSUED-------------------------------------------------------------- -------------------------------------- DATE------__.----------_---- <br /> v�v <br /> AKerm6onsmn6/nr recommendations:--------------------_-------.--------.---_-___________-_-�-.',.-. <br /> -------'---`-----'--------------`—'----'--'------'-------------'-----'-- <br /> - ` <br /> in <br /> 76 <br /> __ �� �� <br /> ;;42 <br /> -- �����-^`��� -~- � "~ ��-' ~' ~/ <br /> --------'^--'— -- ----------'-------------*------�����-�---�--����-��---' <br /> / ^ <br /> � �� ~_"� �� | <br /> �N/\L INSPECTION ��� Dot�-.�^���«���__- =--_.----.�,. ' <br /> - - <br /> , <br /> SAN �(�4�' | HEALTH DISTRICT <br /> /� s� ��� �� � v� � sreet ~ /32 Sycamore Street 814 North "C" Street ^ <br /> StocktonCalifornia �di, California wa"te=. C"kfci,ni* Tw*' California <br />