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• -�FC�OFFLC E UE USE? '., ;-- � c L � i ----------�---3-, -,�. �"- �'' —— Permit No. ..,./Z/. .._� �� 4PPL>ICAl iON FCAUAN 7ATION PERMIT Rr S - '-"""' {Complete in Duplicity) --- - •_ --- ---- Date Issued �. -----.--- ' This Permit Expires 1 Year From Date Issued 'h in Local Health District for a permit to st �end�'in ''+1;th ork h esc�bed. Application is hereby£made to ithe San Joaquin This application is made in compliance with County Ordinance N 549 ......-- T. ¢. - ----- -------- •-_-_. 1 ON-- Q ------------ Phone...__ `f � a - - - ------------- JOB`ADDRESS ANQ�O A J' , Owners Name. z ... . Address------- 1-20-4) 4.: - Phone........................ ..... ` Contractor's Name--------------•---��------------ --- -'- - - --------------------------•• ----• , A artment House ❑ Commercial ❑ ' er rt ❑ tel ❑ Other installation will serve: Residence ❑ p I� Number of bedrooms ___----- Number of bathsWr_. _ . of size __ ��umber of living units:�____.- _ � Il Water Supply: Public system' 'Communi#)'system❑ Private ❑. Depth to Water Tab le, + - ft. // Gravel Sandy Loam ❑ Clay Loam ❑ CI Adobe ardpen ❑ w Character of soil to a depth of 3 feet: Sand ❑ . ❑ ❑FFiA/VA; Yes ❑ IVo ❑ $ t i s .New Construction: Yes o ❑ Previous Application Made: (If yes,date--------------------1 No ❑ R t _ `-TYPE OF INSTALLATION AND SPECIFICATIONS:' i d s (No septic tank or cesspool permitted ' • ` lit s wer is available within 200 feet.) I , { cep Matrri l._ 0 Distance from nearest well - ---.- istan from un a# n_. r� Septic T ,Sri uid de th_s.,�---------•--Capacity. No. of compartments----- - -----------Size. q P• ' t i `x Distance from founds ion . ---------Dis#encs to nearest lot liras_. -•- Disposal eld: Distance from nearest well Length of each line, W------ -•--------Width of trench..--- . --- « 1$ Number of Vines--.. � g <� lengthr T e of material._ - . Depth of filter material------ .._______..------•-� ---�- yp _..Dis ante to nearest lot line_.. __40. 3 ' ' i . 'j + well . ---'-Distant m fo dation_.g�-Q---- to nearestll t Seeps it: r Distance Il g --size: Diameter_---_ Dep#h____•- -- - t Number of pits.---OS...-----------Lining material_ . t I� r ' Cesspool: i�1;;' D'++stance from nearest well----.-_-*_"�.�.Distance from foundation--------------------Lining material_------_-__-.._-------..----'••... els• � Size: Dialmeter.-�-----------•----------------------Depth.------•-----•--------•--------•---- Liquid Capacity- g r" !M t Distance from nearest building-----------_ ------------------------ -- Privy: e Distance from nearest well-----�.-----'----------- r --•-- ❑ Distance to near"est lot line-------------- - -------- I } Remodelin grid/or repairiri (describe}:_____ __ i '- ) ----- ---- ---�-- •-- i ----•--- ---- a ----------........................... hereb certif at I have prepared this'applicatiori and that the work will be done in accordance with San Joaquin County -•--<---- - I ordinances, ate , and rules a regulations of he San Joaquin Local Heath District �y and/or Contractor) ---- - --- -- ----------- -- ------------ ned y B------------------- �•------...---------------- .:. I buildings, a , can be placed an reverse side). [Plot plan, showing size of lot, location of system in relation to wells, FOR DEPARTMENT USE ONLY DATE---- `' -.4 ---- -- -- APPLICATION ACCEPTED BY----------------------------------------------------------- -- -------- DATE---•--------•--•--------•----------------------- I REVIEWED BY------- --------•---- �3 E --- - � f fsJ BUILDING PERMIT ISSUED — il'V---. ------ ` [/ i Alterations and/or recommendations:._ 4;/_ � � ------- ---_---•- I .-- -- ; II ------------------------- :----•-..... r --...._. ... -----••-•---------------------•-•----------• { I ------------ ...........---------------------- --- I Date---- ---------------------------------- -------- ••- -----•--------• FINAL INSPECTION BY _.. ------------- ---- -----•---• --- ------ -� ._.---- •--•• -•-----•----••-------------••-- SAN JOAQUIN LOCAL HEALTH DIST T f 300 Well Oak 51rNt 124 Sycamore Street Z05 west 9th Street �► 130 South American Street Trac California Stockton,California Lodi,California Manteca,California P y 5-6l ES 9 REVISED $-89 ZM At A'8 FY '