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` > <br /> � <br /> � <br /> _~1 �� <br /> � � <br /> — - <br /> APPLICATION <br /> FOR �� PERMIT q ] - ! <br /> x - � <br /> (Complete in Du T�plicafion is hereby �1^ � <br /> �� to �� 3o Joaquin Local Health District for � to ��c+ and install the work herein 6 �bo6� <br /> application is.made in compliance w oun f r j inn cc No..5j47. 19 17 <br /> JOB ADDRESS <br /> '`"". _—_.__—_--_--__— ~ . <br /> Contraotorsmuma),'....---ox---.-----e-----------'--.__----_—'----------_----.—_--_—.,_..—__' Phone----------------------------------- <br /> Installation will <br /> _.---_—_----`'Installationvill serve: Residence EV Apartment House E] Commercial [-] Trailer Cou | Other El <br /> Number of living units: -EP Number of bedrooms E& Number of 6n+hu 2 Lot size------ 1 X/.a0-------------------------- <br /> Wafer Supply: Public system �� Communify system [] Private E] <br /> Character of soil to a depth-nf3 feet: Sand [] Gravel [] Sandy Loam E] Clay Loom [j Clay El Adobe n�' Hardpan ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank o, cesspool permitted R public sewer is m"aUab|o within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material _----------_--_—_ ' <br /> E] No. ofcompartments--------------------------Capacity-----------------------Size--------------------------------Liquid d, tb <br /> Distance �� U foun�uH�n- � �} -- Uning mot�ho <br /> ��- Size: D�m -''--_� <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Disposal Field: Distance from nearest well------------------Distance from foundafion--------------------Distance7to-nearesf-lof-line----7=t_ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------f <br /> | | have preparedthisapplication and +hat the work will be done in accordance withm�mn J�a �� �muntordinances,nn� �n�oo. State laws, and rules and pfthe San Joaquin Local Health District. ' ' <br /> (Signod)--.���..����� ------ ---.. --_---_---------------.--'_--_--.(O*ne, an6/orCmntracfmr) <br /> my:_---------------------------------------------------------------------------------------------------------------------------------L|me>______._______._______._____.. <br /> (Plofplans showing size of lot location mfsystem inrelation tmwells, buildings. o+c,, must be filed with this application). <br /> \Z)- FOR DEPARTMENT USE ONLY <br /> -------------------------- <br /> BU|LD|NG PERMIT ISSUED---------------._--�_—.----- ----- <br /> --------------------------------------- DATE.----_-----_--- _ <br /> AJtemtionsan6/or recommend ufiono;-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------- ----'—'-------------'-------------'-----''-----'-----------'---------'' <br /> ''—'---'----'''----''--''---------'------'--------'----'----''-----'-------'----'--' <br /> ---'---------''---''---''---' --- <br /> -'---'-------'---'---'— <br /> PERM|TNo—�.,�=��-- |�SUED-_ .�—..(Dnf� RN/\L INSPECTION BY�._/, <br /> Dote-''''—__.''' ;;7 <br /> 02 <br /> SAN JOAJ�U|N L{J��� H���7H DISTRICT <br /> , <br /> 130 South American Street <br /> Stockton, California <br />