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~* �� ��� <br /> APPLICATION FOR SA��|TAT\K�N PERMIT �� Pe�rm� N,. '*"�����_- <br /> r � <br /> (Complete in Duplicate) Duh, Issued <br /> | <br /> This application <br /> hereby mu6* to the San Joaquin Local Health D:s+hc+ for * permit to construct and imtuUthe work herein Jo,cdescribed.' `,--|�icofiowithn is moJv in compliance � � County Ordinance No. S <br /> 49. <br /> --� ­'_ ' <br /> ~~~ ADDRESS'AND'— - °�~��L°'� / <br /> -- Phone �n�^�.. ��..~~�~=, <br /> Owner's N ---' <br /> A66�=. -��-�-' �-V� �'~����'�� ------- ........................ -----' <br /> '-----`��'-�� w � =" v � - ~ <br /> Contractor's Nam* - '- --------------- ----------_' _-_ ..... .... - ----- ----------- —. Phone.......................------ ---- <br /> Installation will serve: K��� �� H�� O Commercial � T�A� Court 0 Mn� O Other � <br /> . +� '- <br /> Number of living uniirs: � NI umber of bedrooms �2`=N mo�, " ha f <br /> Lot size <br /> ------ <br /> Water Supply: R/6kc ��nm'^ Community system El Private " '�� +o �u�, Tu6� � �� <br /> � � \ <br /> Character of soil to fv a depth of feet: SandGravel 0SanJy Loam Clay Loam [:1 Clay El Adobe Pe"Hardpan <br /> Previous Application Made: Yes [] NoRr New Construction; Yes [] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , .* <br /> (No. septic tank or cesspool permitted if public sewer is available within 200 feV <br /> well- �_57ri �,_ IA a <br /> Septic Tank: Distance from nearest stance 'rom foundation------ ---r- Maierial---------------------------------- ........... <br /> � ' v�i <br /> Disposal Field: D:,+ancn � "on_-� / --msrance to n <br /> oor"", .", " <br /> "e�_-^-- <br /> Num6oro[ lines.. ^ Long�� of line - 'Vi6th ofiru h ------- ---. <br /> Type of H| | Depth of H|tor mvnu| ��� ,7o+u/ length. ........7 ------- <br /> Seepage Pit: Distance to nearest well------ ----------_- -Distance from foundation............. Distance to nearest lot <br /> � <br /> [] SDiameter_. "e',. _��,� . ' <br /> F-1 41 <br /> Remodeling and/or 9. <br /> ------------- <br /> .,� �ave X <br /> I hereby certify, flatI have prl ared Ws application and th <br /> ordinances. State law�, and rules and regulatgo of e San Jolquin Local Hea <br /> lation to wolls, buildings, efc., can be placed on reverse side). <br /> (Plot plan, showing size of lot. location of system in re <br /> FOR DEPARTMENT USE ONLY <br /> i '_-''___—'--_----- —'---- --------, —'---'- ----'-'-----�---­ <br /> � --'-__-__--__..___------'-__-'__'-'__--_--- .............................. ..............................----------------------------------- --' <br /> -_--'__'-'_-_--- -_----.____------____.__'--'-'_--- '—'-'.'-_--'_'--------_-----_-_ <br /> _ <br /> / � � �� /V— Du*� // ��- � ­-7- ^ ---__—' <br /> , <br /> FINAL INSPECTION BY:-'L�?��-'_-' ----.. ----' -�-~---' -�'--- ------- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> no West Oak Street 132 Sycamore Street 014w=* "C" Street <br /> /m South American Street <br /> Stockton, California Lodi, California Manteca. California Tracy, California <br /> � ss--+-zw B-o novima vv-2/00 <br />