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0 <br /> A. , <br /> A <br /> 4 <br /> )ORLI , * I `_ WA IT 1.4 1;2- <br /> -F.0# -$A <br /> ,T J10N MW <br /> Itirmit <br /> 1% <br /> ;e t r.; <br /> described.' <br /> .,W1_9 <br /> . .Jrjisa,pp,;iP,44oi,r qi;. -..01prlar�pg m .irwrice N':,541. <br /> j <br /> OB' A <br /> .J. ADD 9 Nl�..=Xn6l --------- -- ------ ---- ------- ... ....... ......... -------------- <br /> ........--------------------- ----------- Flkpne---- --------------- <br /> s <br /> Addras . ................. .... ................ <br /> -------------- -------- --------- .......... <br /> ------------ <br /> ................ <br /> Contractors. Name__..e. ...........................----------------------------------------- ------------ .........1*0.nb...........................t------- <br /> InstallatioN *ill.serve:. Residence Apartment House E]- Commercial,o Trailer Co.Ot.t] Motel E] Other <br /> ......................... <br /> Number of living units:•.-_1_--- Number of bqdrootns Number"of-baths�'A.. Lof size ,A.4111- <br /> Water Supply: . Public system ff Corrriubity system El Private DeF�,h to Water Ta6l,6 57.0 ft. <br /> � <br /> Character.of soil to a depth of 3 feet: Sand-[` Gravels[]! Sa:'nfdyloarft' lay Loam El 'Clay [I Adobe[3 Oardpan ❑ <br /> New Coalsfruem: Yes -No ❑ FHA/VA:'-Yis 17� No 1� <br /> Previous Application Madet Yes [-] N o, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic TaA: Distance from nearest well--- ......Distance, from fou gdation---LA---------.Mat r_ial---- - -------- <br /> X_A---if Liquid clep�h-------- ----- ap citwowv---------- <br /> No. of compartments.----- --------Si,e!/,J1t_ .... ----- a <br /> 6m foundation....!_.a...........Distance to nearest lot line_.2:5�!!........ <br /> Disposal Field, Distance from nearest well....to-----------Distance 0 V I <br /> Number of lines-:------- --- -----------L--Length of each line-------- --------------Width of trench....It <br /> ........................ <br /> Type of filter material. .... %NDepth of fiVer matbrial----k At'1---_--__.Total length-----4U......:----------------- <br /> Seepage,Pit: Distance to nearest well----------------------Distance from foundation..............---..Distance to nearest lot line_.._.__`:------ <br /> ElNumber of pits_.._--_- - ..__-_Lining material-----_--_. -._ _____Size:, Diameter------- -----------.Dopth--------------L........----------- <br /> Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material__----=----------------------------- <br /> El Size: Diameter-------------------- -----------------Depth---_----------------------------------------------Liquid Capaci ------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------__--- _______-_.__---------- <br /> C1Distance to nearest lot line--------- -------------------------=------------ ------=----------------------•------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------ ................................................................................ .................................................... <br /> -------------------------------------------------------------•---------------------------------------------- ----------------------------------------------------------------------------I---------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------I ------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ----------- ------I--------------------- <br /> 1 n—e Z)------ ------------------------ ---------- and/or C60'rad8rj <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)--- ------- -- -- -z , <br /> R• 1 <br /> (Plot <br /> Title)-------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).. <br /> FOR DEPARTMENT USE ONLY <br /> 0. <br /> APPLICATION ACCEPTED BY.A*7A0Ki,,j_A&V&'r—---------- ---•-----------------------_-------------------------------------- DATEj9.7__-;t_Z------------------------------------ <br /> REVIEWEDBY------------------------------------------------------------I----------------------------------------------------------------- DATE------------- .......................----------------------- <br /> r <br /> BUILDING <br /> .....---------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE-------------------------------------------------;............�`I <br /> Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------------_------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.............. <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------- ...... -----------------------------------------------------------------------------------------------------------------......................-------—----------------------------....... . <br /> -------------------------------1-1--------------­­----------•f-------- ---------------------------------------------------------------------------- --------------------------- ------------------------------­--- <br /> ----------------------- Date--- - -----------_--------------- ----------- -----------....... <br /> FINAL INSPECTION BY:./_o1__0---- --------------` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />