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-r * ' 14 ' ^ , xApplication ishereby made futhe Son Joaquin Local Health Dist6ctforuperm �jcon�mc� on6 �s�Uf�oro,� 6onv/n ��6e6 i This application is made in compliance with County Ordinance No. S49. . ^ ' � y J{}D ADDRESS AND LOCATION-------------5-4l.--N�..nnw..]��-^°- r...Calif-^.--..__'--_..__-'___-'--- [wner's Name------ ��"-I�°.. � .. -------------------------------------- �_—.,------------- Phone... —_- Ad6nass--------------------- Contractor's Name- _-I2�3��t------------------ -' -' ------------------- -'----------- Phone-,2� - -55-.--.- |nstallationwill serve: Residenco%] Apartment House E] Commercial [] -'-Uor Court [j Motel F] Other E] Number of living units: Number of bedrooms [I Number of baths a Lot size- -.__--__---,.- U Wufer Supply: Public system Community system E] Private E] ' , Character of onU to m depth of fmo+ Sand [] G,uwell E] Sandy Loam E] Clay Loam E] [1*y 0 Adobe 1K] Hardpan � l / TYPE Of INSTALLATION AND SPECIFICATIONS: | ' /No`m,ptic tank or cesspool permitted if public sewer � a"aUa6|w ��n �� fe�tJ ! � Septic Tank: Distance from nearest vo|L---.--Di,hxnca from foundation-------------------Material -.--------.. EKISTUP N� of compartment's----'''--_-.[�poc�y-''''-'�_--G�e--__�-'--_''-Uqui� .6ont6 '''------�-�-�--' Cosspoo|: � ~ Distance from nn�ne�t �uU-.----.D|�nn�: fnom foun6uti�n-.-----L;n;ng maferioL---------.--- [] Size; Diameter-'-_.'''-'-'-__.Depth--'-''''--'''--'''--�_ Privy: Distance from nparesfwell---------------------------------------------- Distanco from nearest building------------------------------------------ All 171 Dist ncefv nearest lot |�ne.__-��________ . ' Seepage Pit; Distance to nearest well_',---------------Distance from foundation-------- -------- Distance fo nearest lot | » ~ 2- Number of �f�_']-------Uning mate6�-.11rl{.�.—S�e: Diumoto�'-��x--._De .- ."-.. � Disposal Field: Disfoncufnom nearest well----------------- -.Distance from foundation--------------------Distance foneonest----^ '--''-- K{IS TMiG Nvm6r, of lines----------------------------- -----Length of each line------------------------------Width of'tn,nch------__�--__ Type of filter material-------------------------Depth offilter material ----''-..-'Ro udoinand/ �adu--- .�,-��.. ...-.. ' _ntle---ta-nk-exiati4�------------------------------------------------------------------------------------ , --''-'_-.-'-''''_-.''`-''---''__.--''-_--'�'-'''-_-'''-�''''''--_'--_.-'''^--'''-�----'-'~-__--_-^ ` . --'-'''�--'-''----'-�-'�-'''--'''��-_--''''---`''-'''''--�''''''--'''__.�'-''--''-'''--''--'_- | hereby certify that I have prepared this application and that the work will accordance with San Joaquin County ordiri State law- _- rules _- regulations _ 'the San Joaquin Local Health District. . ' . T\W1k ---_------_-----._--.-_..}Ownor'an6/*r 'Contram+o,) / � By: 2-r-"�'---'------'»------------'-'-----------''p'°n--^"^�^ -._---__ . (�� plans, size of�� location of system in ��w to wells, buildings, etc., must Lm G�d-*� this e �� FOR DEPARTMENT USE ONLY --..E..E~ ..----''-'''-''-_'�--'''-'''-''��-'�-^-'''—��''--''''- DATE BUILDING PERMIT ISSUED-_--_----_---�--------- ~ DATE' '--' Alterations and/or recommendations:------------------------------------------------------------- ------------------------------------------------ ___..__�__, __��__.__��- / —'--''-'--�-''''''-''''-'--''''''----''-�-_''''__''''---�--''--=~�-'--�''--''''--''--'''- ---------------- ---''-'---'''''-_----_''-_.''''--�__------_—.-''-_'''----.'''� -'--'''' --''-_-''-''-_''_-'�-.- -'-'-_''--'''-�-''-----'''--'''�''--_'-''-_.'��------'''''--'-�'�---_''-'--_-'''__''-�'-'''-_�'_-.--. -_�-��-_----_-- -'''-''--''--�_-�'--''''-_.'''�'-_-''' '-'��'-'''-'-�''_-''--' � PERMIT !-----(Date) RN/\L INSPECTION BY�''��J ------------------------------ '_-'-'-_ � " � - Date' -�/-- ��_ ''''-- SAN JOAQ0N LOCAL HEALTH DISTRICT 130 South American Street ' Stockton, California ss-�-�w v�ow*/wv '~~ }