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:Ry <br /> APPLICATION FOR C< 4 &`_& <br /> I'NMIT .Permit No. . <br /> ». <br /> (C R► Duplicate) E <br /> °- <br /> t,. y <br /> Appli n'(�a made to the San Joaquin La W j,*th,District fofi a permit to construct and install the work rein'd <br /> Th`i pplicatiT is made in compliance with County��inance > <br /> JOB ADDRESS A OCATION..::' / --. ........... r.. , lP [�.> x . ;:._........ <br /> Owner's Name ... ,.. ._ !. _. _G'.1 .. '_ 7. _1 ---•---- •-• _ <br /> Phone: <br /> Address---,i< s, .- �.?!t .C �_...... . ........... <br /> `..tom.: ... <br /> Contractor's Name.......... ... ....... e <br /> ............................ <br /> •U. .f_ Phon .................... <br /> Installation•will serve: Residence a—Xpartment House-0- ..Comm,erc al-_Q Trailer_Cou t `[ Motel (" Other ❑ <br /> / r, <br /> Number of living units: _. Number of bedrooms J..'Number of baths _f size`.._ __ .___-. <br /> - _. ......, ,. <br /> Water Supply: Public system �''�Community system [Private ❑; Depth to Water Table ft.. ' <br /> Character of soil to a,depth of S feet: Sand❑ Gravel ❑ Sandy:Loam a Clay Loam❑ Clay❑ Adobe span 1 <br /> m an <br /> Previous Application Made: Yes ❑ No [j]/New Construction: Yes [ 4ra[ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ­­­ <br /> (No septic tank or cesspool permitted if public sewer is avail within 200 feet.) <br /> Septic T nk: Distance from nearest well �0Distance fcotr► oundaation -:�f__6 ... ,,t/".++f <br /> Mat nal,' t' ` <br /> No. of compartments__-. ^_.. Size_.4.c. --.' -.�' �-.___Liquid depih----' --- pacity. , '. _r <br /> Dispose ieicl: Distance from nearest well `�d Distance from foundafion j-. ._.Pptance to nearest to arte� <br /> le Number of lines-- L ri Len9th'of-4Pech-4ine..-.6.Q' ifO'f!dWidth.of french. ...7.7.... --•- <br /> Type of filter matenal__._IIt _ fi ..,['_ ......._ Total length <br /> - Depth of material.._ <br /> p -well <br /> .._Distance fr m foundation. ? r.Dista, st <br /> AA <br /> See a it , Distance to nearest well <br /> p � <br /> Number of its__. A .....Lin nig materia) iKK-Size: Diameter.... �",�__-=-. ^�H <br /> Cesspool: Distance from nearest well Distance from foundation Lining ts$ <br /> ❑ -- - <br /> Size: Diameter_.. ......... ........:........Depfh_-_. <br /> q P .. ' - a <br /> Privy: Distance from nearest-well---,---.--­-- ------------------------------=Distance from nearest buiit##ng-.--,.: ...__ <br /> ❑ Distance,to nearest lot line....... <br /> Remodeling - <br /> e tug and/or repairing (describe) .._._. ._ <br /> ........................................................................... ...... <br /> __.._ .. .. ........................... <br /> ._............ <br /> I hereby certify that I have prepared #his applicefion and fh fit-the_work will be done in-accordance with San unx Coua <br /> - <br /> ordinances, S# Taws, aad.rules grid rFe pions of the San Joaquin Local Health District. � <, <br /> (Signed .1 !,,i,f tra <br /> �r:. ,, .•- -and/or Con ctorN <br /> •-_... ••... ----•----(Title)._.. : a <br /> i --... <br /> (Plot plan. showring size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse <br /> V FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...................... DATE:. <br /> REVIEWED BY'`= I.;6*�* DATE._ tix <br /> BUILDING PERMIT ISSLtI ?.. :. ....:_._ .... ---- •----- :- DATE• , <br /> Alterations and/or recom ................... ., <br /> -----•-••--••. .... ��- ------...1 •' . .... __ ...... .......:. ............................................. =a <br /> � r <br /> p . <br /> FINAL INSPECTION BY:..... <br /> Date i <br /> SA4-JOA96IN LOCAL HEALTH DISTRICT <br /> 130 South AmericanStreet : 300 Wilt Oak Street 132 Sycamore Street 014 North "C`rt girt f <br /> Stockton, California Lodi, California Manteca, California Trom C wends <br /> E8--9-2M 145446 ATWOOO 77.54 <br />