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0 APP�rcArroN For2 sArvr rarroN PERMIT (Complete in Duplicate) T�,plica ion is hereby made to the San Joaquin Local application is made in compliance with 'Health District fora JOB ADDRESS AND County Ordinance permit to construct and install fine work N o. 549. , Owner's LOCATI N herein described. Name _4 0...... Address-.__ -- --- - -- - -- 46 #" Contractor's ----------------------------- ---- ---- ------- Nama---- � -------------- -- ------------- -- --- Phone-------- -- ----- �- lnstallation will serve: t ------------------- ?� ----------------------- -- ------ Residence 9 --- - Apartment - '�`��,.�a--- -- ---------------------------- ---------------- --- ` Number of living House ` ❑ Commercial ------------- Pbon -� �--�---- Water g units: Yt Number ❑ Trailer Court SupplY: Public system °f bedrooms ❑ Motel -- " ❑ Community � Number of baths � ❑ Other ❑ Character of soil to a depth of 3 feet: y system Lot size___1*44g e t ❑ Private x - 1 ------------ Sand � Gravel # -- ----- ---- TYPE OF INSTALLATION AND Y Loam ❑i Clay❑ Sand t No se SPECIFICATIONS: Y Laam ❑ Clay ❑ Adobe )4 tank or cesspool er Hard Septic lank: P miffed if P pari-❑ + Public sewer is available within fee#,] ❑ Distance from nearest well No. of compartments-_ ------Distance from foundation_____ _ Cesspool: :r------Capacity -----Material-------- Distance from nearest well.......... - ----------Size--------------- --------------------------------------- Distance - ------- , Size: Diameter----- Distance from foundation__ --- Liquid depth ------------- ----- Privy; � Distance from nearest well------------- Depth--------------------------- -------------.Lining material--_ --- ❑ ......................... ------- -------------- ---------------------------------- Seepage pit: to ----------------------------------- - nearest tot line----------------- Vi Seepage Pit: Distance from nearest building---- Distance Distance to nearest well ---- ---------------------------- -- El Number of --------------Distance from foundation_, pits------- ----------Lining material -------------------- Distance Field; Distance to nearest lot lire Number from nearest well -- ----- -----Size: Diameter of lines----- ----- , De - -----_.D�stance from foundation_____ / pth--------------------------------- ---- Distance to nearest lot line___{„` Type of filter material_ ,(y-h /": Length of each linof_O cr .r Remodeling Depth of filter'material____f ��------Width of trench-__--- __Y g and/or repairing (describe): -- + ---------------------- - --- - ------------- ----------- -------------------------------------------- -------------------------------------- ------------------- -7 ------------------------------------------ --i----------------------------------------------------------------------------------- --------------------------- -----------------------------------I hereby certify that I have rdinances Prepared this application and that the work will be done -- a-------- __- -------------------•------ State laws, and rules and regulations of the San Joa Joaquin Local Helpealth Distric#. - - -•--•- - 'gned)__--- �- � ccordance with San Joaquin County Y �` - + at plans, Showing _ g size of lot, location r C n}r of system in relation to wells, bui-din -- etc. a (Title}_-�� o ° ctor] g � must be filed with this a FOR DFP pplication), :ICATION ACCEPTED BY-- F ARTMENT USE ONLY 'WED BY ----- ------------------------------------ -- --------- --------------------------------------------- DATE--- -- ` - - ------ --- --- ------ -- --- --- - - -_' `1 ---- PiNG PERMIT ISSUED-ons and/or recomm ------endations:_-------- ----------- - -- ------------- DATE ---------------- ` ------------- DATE --------------------- ----------------------------- ----- ------------- -------------•------------- --------------- ------------ --- - ------------------------- ---- ISSUED 3 ---- - (Date) FINAL INSPECTION BY:---J- --- �- i - -- ----------------------- Date--__--- SAN JOAQUIN LOCAL HEALTH DIST 130 South American Street RIOT '0 W-1539 Stockton, California