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� - / . �� T�� '�� ~ Permit No 4-fei=n-_-� (somp/ere � C�o �e) Date Issued //� /e74�� Application is hereby � made to the San Joaquin Local Health District for u permit to construct and install the work herein described..- This application is escribe6~Th|oopplicutionh made /n compliance with County Ordinance No. 549. ^ JOB ADDRESS AND U]CAT| }N-'.5/-Y�-. 5;nkTp1l-_---.---------_---.-----.-- = }wn°r's ------e~;�!mks--._-._ --------------------- ------------------ - ----------------------------------- P6one-L-kr'743------------ Address___--___.. w ------__._..__._'-_____.._-----__-_----_.--__---------__. , Contrao+ors Name---------------------------------------------------------------------------------------------------------------------------------------------- Rhone-----'------------------------------ Installation will ''-''''--'-'|nstallationvill serve: Residence �� dmm� H�� Commoca| ETmJm Cot EMoeEOe, E ' � '�' 1 �� . ' mum6erof |��ng un�o� ..-' Nvm6erof6e6room, ~*~' Num6er nf 6�+h» -�.' Lotozn '-u.'�`'.-'/'`'�-''�'''--'' Water Supply: Public ,yoham RM Community oyoham El Private [] Depth to Water Tu6|v --- ft / Character of onU to depth of feet: Sand F] Gravel E] Sandy Loam E] Clay Loom [l Clay El Adobe Hardpan [] Previous Application K4a6o, Yes>� No L] New Construction: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: .Nn septic tank ~ ~~~~r~~| �~'^ ''~6 ' ^~~~' '^ ~`~^~6 '~ ~^^^' ~~~ '~~`^/ x� / Septic Tank: Distance from nearest ' .- Material--- No. of oompo,t"ents--"�.-----Size.]XVX-3 I---------.Uquld dep!h-.-q.�-... .........Capacity--- Disposal Field: Distance from nearest wO b�~ Disfance from fqu cl ^)' Distance to nearest lot | ^ S/ �� Number -------- ,r ||n L�ng+ o[ nuc� U of c6 Type of �|�,r material--Cpx�&---------Depth of filter material------iT-�--------Total length---------/�I 0--------------------- ) » Seepage Pit: Distance to nearest woL-'''''''-Distovon from foundation-------------------Distance fn nearest lot line'''---'' F-1 Number of pits------ ---------------Lining material----------------------- Dimmo+ec._---._Dup1h-----------_------ : Distance from nearest well '''-'--Distance from foundation-----''''''-Lining material ''-''''-''-'''- ^ El Sba: Diameter-----._--.__Dooth._-._.___.---------Lioui6 Capacity------------------ ---------gals. K�� � & Privy: Distance from nearest well '---'---'-_.''----------Distance from nearest building--------------------------------- Distance to nuons,t lot line------------------------------------:----------------------------------- --------------------------------------------------- -_---- Remodeling and/or repairing (describe):-'-_'�''--''--''-�' ^ ''--_.''''__.----'-'--'_-''---'_-''__.''--''-_ , -_-._-_..____-_-_-_--___.--__.___-_----_..----___-_____.--'-_-----.___------_-- � -------_----_---_.--'___--__-.-__-'-__.---___._-.._-___-____-_.--_.__'._------' ---_..--._---'-_'_----'__.___-'-__._-_.��-_^-~--__-_--_-__-_-..__.___-------------' | here | kmvu f�s that the work will be done inaccordance with San Joaquin County ordinances, State laws, and rules and of M6 San Joaquin Local Health District. x (Signed)-'61. .�---_----_.L-----._-------_---_----. and/or Cnn�uc+n� � ' By:--_'''-_---__.-_'--''--_''-----''---''''_'''-_---''-_.''' --_-'-'-'_-._'''-'_'''-- (Pnt plan. showing size of lot, location of system in relation to */eUs, buil6ingv, etc. cun 6w placed on reverse s;Jo}' FOR DEPARTMENT USE ONLY Of APPLICATION ACCEPTED DATE----- __qeral ons a o r L ----------------------- ------------- �--------------�---------------------------_-----------------------------------. . F|N/\L INSPECTION 8Y:_4 ------------ Date------ ------------------------------------- SAN nu----------_ SAN JOAQUQN LOCAL HEALTH DISTRICT 130 South America" etreot 300 West Oak Sfreet /32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California rmov California ES-9-2M /n'52 xov�,°6 W-z/nn