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n � J APPLE - r� carloN FOR saNrrarIoN PERMIT, _ (Complete in Duplicate) Permit No. - Application is l This application made to the San Joaquin<_ pplication is made in co q Local Health District fora Date Issued mpliance with Count _ y Or ante Permit to.construct and install the work herein described. JOB ADDRESS AND LOCATION_._ No: 549. Owner s Namo ----------------- ' L J Ga1��L Address. -- - F ------•-- - -, Z --- ` Contractor's Name__._ -•��-_ • Inst alfa}' --- +on will �;a � serve. Residence U Apartment House /� _ :;- � � . �, Number of living ❑ -Trailer ✓ Phone__.---_-_ g units: __�-_ �❑ Commercial Water Supply: u - Number of bedrooms . r Court ❑ Motel - ---- Pp Y: Public system ❑ Community - Number of baths _--{-- ❑ O�her El Character of Y system --'Lot size soil to a depth of 3 feet: ❑ Pr, to V Depth to W �f, �' : ' Sand star Table --- Previous-Applica}ion Made: Yes ❑ Gravel; ft ❑ No r . Sandy Loam❑ Clay 'TYPE OF INSTALLATION New Co nsfruCtion: Yes ❑ No Loam ❑ Cfa.y ❑ Adobe (No septic tank or cesssp�l permitted TIONS: FHA V Hardpanl= / A: Yes � No if publie�erver is available within 200 feet'.) Septic Tank. Distance from 11 dnearest wel!_.•- _ _ No. of compartments Distance o(n { Disposal Field: partmentsrt ation---- ! . C( { Size 7C r F Mat rial Distance from nearest well- , p f ------Liquid d1. epth_ C/-- t � f Number of lines------ - D stance from {oundation'_,- t, ------Capacify_- a0--0V2L.( - ��----`---_--Distance to nearest lot fin --- Type of filter material___- Length of each line-_--_-pp ! DD--_- -----------Width of trench.-__ / S page Pit: - Depth'of filter material_---- �r Distance to nearest well-_ -- - ----Total length - �� ---- Number of --------------Distanee from foundation------- 9 __�-. Pits.........------- ----- - ------- ----------- Ces pool: Lining'- maferial___- -• •.Distance to nearest lot line--_--_--_ Distance from 'nearest well------------t Size.`Diameter-------- Distance,from foundat onL.�r Depth_ --- - - - Size: Diameter-- ------ Depth 27" .,--------.Lining material Priv �. Distance from`nearest well -- _ j ti-Liquid CapacitY als. I ---- - Distance to nearest lot line__ ___--_-_- -Distance from nearest building g ----- N Remo eIin and/or repairing [describe):___---_ r �• --•------ ----- g /� =-- I/ --------------- '----"------------------- --•----•---------------------------•------ f----------------•--_-------•--_.__`---`------------------- ---- -------------------------------- -------------- ------------- _ - -------•-. ----- ` � --., _ - ! hereby certify fha} I have prepared- thi = -- ` P P this applica}ion and }ha} the work will be done, in accordance with San Joaquin Count nces, S }e-laws, and rules d regulations of the San Joaquin Local Health-District. ordinances. ___ ---------------------------- 5, ned Y -- ----- -------- ---------------------- ----------------------------- BY --------------------------------- - (Owner and/or Confraefor) (Plot plan, owing size of lot, location of system in reiafion to wells, buiidings,.etc., can((Title) placed on reverse side). FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY_ __________ �EVIEWED BY ---------------------------------------- DATE � �- 3UILDING PERMIT ISSUED_____-_•__- DATE______--_ -- •--------------------- ---- --------------- 4 aerations and/or recommendations:------ ------ --- -- ------- --------------------------------------------------- DATE------------------------ ------•---•-------------------------------------•------------------------------------------ L ________ __ -__..___-_-_•__._ ___________________________________________________•_ _____________________________________________________ FINAL INSPECTION BY:, ------ 'z Date _4�`_0----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 34o West Oak Street' t ! 132 Sycamore Street Bla North "C" S+reet Stocktonl California Lodi California 1 ij, Manteca, California til 1✓ Z Tracy, California E5---9---2M , Revises 1-57 F.P.CC.