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------------- ..... -4,� _ t This Permit Ex ires 1'Year From-Date Issued _ " pplication isr hereby.inade to the.5an J aq in Local Health District =,or a permit to construct and install the work herein descried. A This application!is made in compliance with County Ordinance No.;547. ------------------- ----- ---- JOB ADDRESS,jAND:LOCATIOgj�l._ ._: _ _ ..-- -n- - ---- f ►f Owner s Nam , �fi•- '- - '-- ------------ - Ph ------- -----------•----- w one � ---- � . Address.----; �_ -----------= - F !tk� ----" Phone------------------ ---------------- Contractor's -------. . Contractors Name-- ..._ .c+t�_Y1 _ ------------- ----'- i------------------- . - -=. . rths Z"La urt�❑ Mo#el ❑ Other ❑ Installation ��I��erve: Residence (�. Apartment House ❑ Commerclao{ Trader ��`� `2" t tuber of livingunits: _-"�-:- Number of bedrooms _.'5__ Number t:slze � = --- `�---------------------- Num "" h r�r Water Supp li1. �Pubblicystem ❑ ,j'Cammunity system ❑ Private QVDepth to Waterr Table (p_O 3. -CIa <.Loam Cla ❑ Adobe gi Hardpan ❑ [ ' Character ofJJfsoil to a depth of 3 feet: Sand ❑ Graver[] . Sandy Loam ❑ y, ❑ Y W 1 i l •Construction: Yes ❑ No ❑ FHA/VA::Yes ❑ No ❑ I` PP y . Previous A lication Made. (If es,date'-__"-_-..,_"- " - l No ❑ New on P. l f i I 0. !I ..� TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank Septic cesspool�permi#ed if public: sewer is available within 200 feet.] I Z Mgterill__0-_Qyl 'F' � ------------ Septic Tank: Distance fromnearest well_".��_-."-Distance from tfoundation___-. � Y P #Y )Q No. of compartments------- --._,-- ----Size--3__ - -?�- -=--Liquid depth- -- ---------=---Ga `aci li r " F Disposal Fie Distance from nearest weII..,J( "__.._.Distance from.foundation----_ ---_----.Distance to nearest lot lig e"_ "___"-__." 1 1 •." ,- - Length of each line_-_F G% e..Width of trench_- .f_-_--.-------------� Number of lines-------------"- T( _ .Type of filter.materi6l5 �- 1r_�C� -Depth offilter material_- j_ ----------To#al length------•----- ---------�'` -- Number of pats-._______------------Linin ma#enal--"_"_"--___"."-:-__ , ___�.--". l Seepage Pit: Distance to n�arest lWell ell..."-._____.__"___Distance from'' foundation------- Distance to nearest lot line---"..____._-_-_- Size: Diameter-----------------------Depth--"_.____..___.________ - _-•_-- a Cess❑ool: ; Distance from nearest well-___.----"_--""-_Distance from foundation.--._-.J_--- -----.Lining material-------------__--_ ❑ I Size: Diameter,.------- �� - Depth-- '--•------=-!-----` .j_-rLiquid Capacity------ gals. y; M i ,.,ar�•e, r Priv } w DD li r l _Dijance from nearest building - - !stance from.nearest well ----- ---- --- ----r r _ i _ ---------------------- ----------------- -------- -----'- ,� ------------ tante to nea s - Y { r - --- -------- ------ ------------------- --- -_ ---_-------"_""---_-. """- d°asci be --- -------- Rer � g r n r l - - - - --------- ------- -------------- ---l-F---; ------------------------- `_ ------------------------------------------•------- - ------------ ---------l-----•-- ---- ----- ----- I here 6 certtf ;that I have prepared this application and that the work,will be done in accordance with San Joaquin County ordinances, S �te laws, and rules'.and regulations of the San Joaquin,Local Health District. l t i f -------------------------- (Owner and/or Contractor) ►- ��'� (Signed)----- �: �"-�� - � -------- ---------; + i • _ t .9 (Title) of plan, showin ix; of lot, to�ation of system In relation to wells, buildin s, etc.; can be placed on reverse side). (PI p r i owing 0l k �i FOP, DEPARTMENT.USE ONLY t -------------------------------- ---------------------------------� � DATE---�}--'-�--g--' �'�------ ----------- - BY ACCEPTED BY--�-� �- - ' REV EWER DATE--------------------------'---- -------•-•------------- ON BIiILDING PERMIT ISSUED 4 --------------------------------- _ _ ------------------- -------------- ,rations :- =--- DATE.---------------------------=-- --------------------------- y Alterations ani or recommendations:--.'_.._"--------------------- ---- - # -------------- ------------------ -------------- it I u -------------•----------"-------------------------------------------- .................. ...----------- ----- -----•------------------- ---- 1! ------� ----------- ------------------- ---- ------`-------------------------- F `-------- - ------- ----------------------- -'t-i}f"'" 1 i --------------------- -- - 1 I,I Date--------------/----- ---------- FINAL INSPECTION BY:...-114-- -- ------------Q'---"---- X AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street i T Lodi,California Montecar California Tracy,California 'Stockton,California £5 9 REVIfiEO 9.59 31A 3-'63 F.P.Co.