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�r �� <br />FOR PERMIT(Complete in Duplicate) ' Permit No. <br />- \^ <br />K 'Dnte Issued. - A0 <br />' <br />! <br />�ut �� no�v mu � �fu ��e San Joaquin Local Heo|H` Di�t�ct�na ponn�fo 6 i U+h~o, herein 600c,�od. | <br />.�/ application .�m�Jein cn�cJ�oncn with N 549 / <br />/ o - | <br />-------------------------------- <br />------------------- <br />I J --- OP -3 -Alt I ------------------------------------ --------------------- ---------- Phone ----------------------- ------------ <br />A66 -- -- ----`- ' i <br />Installation will serve: Residence JA Apartment House Ej Commercial E] Trailer Court 0 Motel 0 Other E] <br />N'Number Of living units: �- Number of bedrooms _3---- Number of 6ut6o�l ------ Lot <br />-Lot oizo � <br />- <br />Wato, Supply: Public system ECommunity system FIPrivate E] Depth to Water Table 46--ft- <br />Character <br />\/ <br />�of soil to a 6aofh nf3 feet:3un6 E] Gravel ` [] Sandy Loum[] {Jay Loam E] Clay A6o6n4l Hur6pon 0` FH [�� <br />Pm�Application Made: Yes � No [� New Construction: No [-]A/v*. Yes No o [] <br />TYPE OFINSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permit4id <br />—if publicoew*r isavailable within 200 feet.) <br />Septic Tank: Distance from nearest Distance from foundation --- I 2-,- kator*_u|C .__---- <br />- <br />--�No. of compartments --- '�..y�0 ----- Liquid 6 o�h --------^^ 1 ------------ Capacity .00 <br />0 ------ <br />Disposal Field: . Distance| w <br />- <br />cz�___ ____������� _ <br />p o6 <br />Seepage Pit: Distance�to , nearest well ----- X ----------- Distance from foundation --- 91) _* --------- Distance to nearest lot lineAS-* ......... <br />''~---� - ,—'--'--������ ' ~-^- <br />its <br />' Distance 6n foundation Lining material- <br />' ' Liquid Capacity /s. <br />---- <br />! ---' <br />-_--.-.--_-----_--__-_---_'-____-�--__-__----_-__-_-_ <br />_-._--._-_-_---''--� <br />-_'—' <br />'---------'---------------------���'- <br />hereby certify that �)��df6o -work will 6e Jon'ein accordance with Sun Joaquin County <br />ordinances,. and rules and regulations vfthe San <br />/ <br />Joaquin Health Q�f��t <br />and/or Contractor) <br />' 0igno6l-----.-]����'''��*����-����g�'��m� <br />-� Bv;---------------------------------------------------------------------- <br />(Plot plan, showing size of lot, location of system in rel/ i n --to wells,' buildings, etc., can be placed on reverse side). <br />FOR-6EPARTMENT USE ONLY <br />__.�_���_-_--.--___--'bATE' -<�L.--_._---' <br />~APPLICATION ACCEPTED BY � DATE <br />REV|E\�B}DY---------------_------_------'--'----'-----' -'----'-------'^-------' <br />D/A�-- <br />DU|LD\N��PERW|T|SSUED---__---.-_----_-.--__._--_------_' '-____--_-_________ <br />AKo,ationv*n6/n,.--.--------._---------_-__---_--_-._---.--__-_-_------__---- <br />----------------------------------------------- -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- <br />----------------- --------------- ------------------------ -------------------------------------------------------------- ------------------------------------------------------- ------------------------------ --------- <br />�' <br />----------------------- ----------------------------------------------------------------------------- ------------------ ------------------------- -'---------------------------------------------------- ------- --------- <br />'- -'-,--'_''------_--'—'--_'--_--_-'---''' <br />----_����� <br />` / <br />. � <br />FINAL INSPECTION 8Y�.Date '' --------- ------ <br />/SAN J0AQU\N LOCAL HEALTH D|ST�CT <br />130 South American Street 300 West Oak s*°*t � /ao Sycamore Street o/+ North "C" Street <br />Stockton, California Lodi California Manteca, California Tracy, California <br />