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' ~d -/ f}.[�0L- A APPLICATION FORSAN�ATIOIT Permit No. -2 ^J-9{ -- � ' (Com-olef~ in --'—'-' Date issued is hereby made to the San Joaquin Local Health Dist rict for o permit to construct and install the work herein described. '. This application is made /ncompliance-with County Ordinance No. 549.JOB ADDRESS AND LOCATION------ � - -------J-1,4153LA.-d'------ AZ 0-11".V�e A'A e----------- � -------------------------- Installationwill serve: Residence N Apartment House E] Communo|m| [] Trailer Court [] Motel [] Other [] � Num6erof living units: 4- Nu' 6erof.6edn,oms I- Nun"bu, of 6o+h, /-. Lot size -- --------/ /�o-___-'_ Water Supply: Public system Ej . Community system El Private X Depth to Water Table t-42' ft. Character of soil to u depth of 3 feet; Sand E] Gravel E] Sandy LoamF� Clay Loam El Clay K Adobe E] Hardpan E4 ` Previous Application Made: Yes No 5fl New Construction: Yo, GJ No El TYPE 0PINSTALLATION AND SPEC<FICATk3NS- ' (No septic fank'o, mompnn| permitted if public sewer is a"a3u6|e within 200 feet.) ' / Septic Tank: Distance' from nearest weU��x.�,��D| from No. of compartments----------------3izc..9t.'Vjr.-1�---------Liquid 6epfh--.�t--------------C*pod+y-'��!��J�-..��~ ~� Disposal Field: Distance from nearest weU/'+~ '�X Distance from founcl ' Distance to nearest lot |i Number o{�|inos _- �' Length of each line ---------------Width of tnanch ..2.Y-'-''-''-- ' Type of Cte, mo+rriaL..jDepth of filter muha6uL.-/-?-------------total |ono+ --_6.Q_'-_.-_-- Soepuge Pit: Distance to nnv,n` weU-''_-'-''Distance from foundation--------------------Distance to. nearest lot line----------------- 10 Number of pits-------..Lining material -- -----------Size: Diameter----------------- ---Depth_-----_-.-. : Distance from nearest well ''--:-----Distance from foundation--------------------Lining material .-''--'_-'--''- [] Size Diameter- ---------------------------------Depth----------------------------------------------------Liquid Capacity------------------------------ Privy: - Disi nc: from nearest well O�+ ncr from neu�st6ui��g'-�-'-''---_''-'-' . - ��_=�`�� ==�� . [� Di��nc� +vnb:ra��o+� ----'-'-_.--'___''---'''--'`''--''--- Demo6ning °m6/or ropoiring (6oncribe�.------' ---------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- '-----'----'-----'--------'------' . . -------.--._-------_'---_-----.^.__.--_-----__-_----'-_-..__----__--__-.--_--_--_- ---_-_-----_----.-_-..'_--_-_--__.--_--_'--_..--.---'''-''-_--'------''-''--''---'---' �. I hereby certify that-I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Son Joaquin Local Health Diot,|of' /S}Qno6Lz ---------- -------------------------------------------------------------------(Owner and/o, Contractor) By: JTlt�� _._-___-_._--'--'-------------�-'---`-'--` �-,------------------- ^ (Plot plan, showing size of lot, location of system in relation to wells, builclingstmtc.. can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED �L--. --------------------------------_-''-_--.. D/�'E�?.�&r�_�_�..6------------------------------- REVIEWEDBY----------------------------------------- -------------------------------- ---------------------'_--'''__ DATE'-''''--_-----_-'----'- < 8U|UJ|NG PERMIT ISSUED L-----'-''---''1�'' -----------;-----''-'''�'-''''-'-' D/AE.-'-'''---'~-'--'-'-'_--'- and/or ,ocommen6atiorm;'-4=wa ----------------------------------------------- .. ------------------------------------------------------------------------------------------- -------------------- ----''_''--''-'''_-.-'''-��'��--'-''--_---''-_''-_''`-'---''---'-__'---'_-_--.'-''' --'^'--'---'-''''_''-'''-''-''_''-''--'''-''-_''-_'-''---''-'---''-''-''--'---''---'_-_-`--- ' . --'--'-'-''-'''''-'''_-'---'-'�'-''-'''-'''--'-'`'--''-'''-�'--'-''-'''-''--''---'''-'-''-'---- --''-'-''-''-�'--'--'---''-''-'--'''�.--''--'-'---'--''_'�'-'--''-'''-'---''_-''-''--'--' � FIN L2 INSPECTION BY:. --'''-' Date''''r -'---'-'-_`--'----''-'- � SAN JOAQU|N LOCAL HEALTH DISTRICT /30 South -American Street 300 West Oak Street /32 Sycamore Street owNorth "rStreet Stockton, California L*d/, California w""te,". California n="'. California - ES-9-2M Revised W-2100