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-�--- <br /> :7� A ����� � � �-�� �� ��' ��� � � ��� V � Permit N� �l'�'.���_-- <br /> - <br /> _ , � ` Z�^ (Complete in Duplicate) � - q <br /> Date Issued - _'.-�-'. ' <br /> --------------------------------------------------------- This Permit Expires I Year From Date Issued . <br />| Application is hereby made tot1fe-San � opermit to^ construct and install the <br /> [I!V <br /> r This mapplication is made in compliance with County OrdlinammNo. 549. <br /> JOB ADDRESS ' <br /> ______.______________.-_------. <br />/|| <br /> . }wnersNume.............. <br /> ^... 5.ml-. - <br /> ____.-__-�-, <br /> -.__^ <br /> ___--'_--_. <br /> . <br /> Cuotrmctu,o N - ' ----------­--­--- - ^__ ' - '_'----__-_ <br /> Phone------------ _will _- <br /> ���� H�e � ��m��� � l�|�, �� � �� � ��, � <br /> Number cfliving units: ---4- Number ofbedrooms�| '3' Number ofbaths ........ Lot size _-�__^� _-_--. <br /> __--Water Supply: Public system �� Community system [] Private [] Dou+6 to Water Table ---' t <br />' <br /> Character of nmR to m depth of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam [] Clay [] A6o6miz Hardpan [] <br />/ <br />. <br /> Previous Application Made: Ufyoo'6ot�'------') NofK New Construction: Yes [] No Jig., FHA/VA. Yes C] No it" <br />. ~�~� <br />| TYPE OF INSTALLATION AND SPECIFICATIONS; .(No septic*eptic |mmk or cesspool permiftedif public sewer is available within 200 feet.) <br /> To'pkDistance from nearest *eU-_^......-,Dbtafrom --------------------Material '-''-'---_.____..__' <br /> N of SizeO.-O. -_ Liquidcleo <br /> is o: Distance from nearest // ./e _Distance from foundation.-/& <br /> ^ - <br /> Number of lines-------------J Length of each <br /> |in��e''...9< .�.-...--. Yi6f6 offmnch--..,�-------------------- <br /> I <br /> �'' V ' ^Type of � gth----.-. .-- ^ - <br /> Pit: Distance to ' ` -- ^ t � ^� <br /> Number of pits_.--_!------------Lining moteria Size: Dkumeta,-'�^ » q ^ Depth----------� <br /> '-- ^� <br />/ <br />| cesspool: Distance from nou,e, well----------------- from foundation.-------- mutoriaL-_.--_._----_' <br />' [] Size: Diammh*r- ---------------------------------Depth----._- ---'-_--.__Liqvi6 Capacity---- <br />| Privy Distance from nearest well <br /> ----------------------------------------- -------- from nearest building '---____.__-_--' <br />/ [] Distance +onearest lot |in,�._�.-_-�_-�-----.�_...____----._-______.__.__________ U <br />/ . <br /> Remodeling and/or repairing (demzibJ ------------------------------------------- ............... ------------------------------------------------------------------------_---_ <br /> _---_____-----'-_---.--____-._-------_-_-___-__._---_-_---'''---'__._---_-.___.-_- <br /> _-_.---_-'--_--''-__-____----_----_--------.--_-__.___.-____._--__-.._-_-___-_.---_-. <br /> -----------'— ------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I here66m°m accordance with San Joaquin County <br /> ordinances, certifyLofe laws. and rules and regulations nfthe San Joaquin Local Health District. <br />' (��y^u6L'��. <br /> ....«�T:------- ----------------------------------------------------------------------------------------------(Owner and/or Contractor) <br />| <br />//| <br /> By:...............----------------------------------------- -------------------------------------------'-- .........(/ ' ---_---'-- <br /> '--------- <br /> (Plot plan. showing size of lot, location of system in relaflon to wells, �~'' �� can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br />' Ah*rwfhonuwnd/*, roo*mmwn6atiwmm:-.-----------------'--.._----.-'-'-..-.....-.--.-.-..----_----____-. <br /> -- ---------------------------------------------—------------------------------------------------------------------------------------------------------------------------------'--------------- <br /> ` <br /> - <br /> -------------- <br /> -------------------------------------------------------- <br /> ----'������'����''�''���'�''��''�'''��''���''��'''' <br /> 'T-'--'-''-'-------''--'-'--'--- <br /> ..............'-'----------------- - ' ''-' -''--'-_--'_-''---'-_'-^,-----' -''__''-'--.-'--'-'-- <br /> FINAL INSPECTION BY��`^-c -----------............... . Dmt.......... <br /> -.. -------------------- <br /> � <br /> ��� J����|NL���� ���L�fD�T�CT ' <br /> 130South American Street 300 West Oak Street o^SycamoroStreet 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California �cy,California <br />| "" , "En"", ".°" °= "_". ="" <br />| � ' <br />/ ' <br />