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FOR OFFICE USE: <br /> 3 <br /> ...............................................•--•..... Appuwm Fort smiwm Pewly pomit No. <br /> ........................................................ <br /> ......................... .......................... (Conpbto In Dupriecto) pato Issuod <br /> --....•-•...... <br /> ­......... --------- This Permit Exgiros I Year From Dato IwU0d <br /> Application is horoby made to the Son Joaquin Local Health District for a permit to construct and insftll the work herein dwrilb-,ed. <br /> This application is madojn compligacawith County Ordinance No. 549. -0 qV__55r <br /> -7 <br /> "mx. 90, <br /> ................ <br /> ........ ....p i <br /> &.. .... ... <br /> Owner's ...................... ..................................... <br /> . <br /> Address---------------- -------w................... .................— .. ........ <br /> Contractor's Nam ....................j ....... Phono.................... <br /> o <br /> Inst&--fian rAM servo: Residence �j Apartment Home 0 Commercial 0 Trage, cfff Motel 0 Other [3&2AAcn4--_.--.--•---•----•-...--------•_.....: <br /> Number of living units: L__ Number of bedrooms_J.. Number of baths Lot size <br /> Meter Supply: Public system 0 Community system El private Ep Depth...ro Water Table-3-0- ft. <br /> Chcrcctcrofzw1foado0hof3fcc#: Sand Gravel [] Sandy Loam[l Clay Loam O.-Clay 0 Adoboo Hardpan <br /> Previous Appncaflon Mcdo: (if yes,date--------------------1 No jo Now Construction: Yes ia No E] FHA/VA:Yes 0 No 0; <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No tcprm tcrt5 cw ces:poA p=mlftod if public&war is avcilaWo wirttiin 200 foot.} <br /> oy- ------- <br /> Septic Tank- Distance from nearest well-f-0.......Distance from foundation.-.. <br /> 1-42MaLiquid depth I ----- --- <br /> t <br /> No. of compartments_ a..................size"- A <br /> Capacity../ <br /> Disposal Field- Distance from nears well,414)........Distance from foundatign-A7 ._........Distance to nearest lot <br /> Number of lines ..........Length of each IineY0q._.!�.2V?.__..Width of tronch-AV-�t----------- <br /> : <br /> ..... IY <br /> Type of filter �;iei ..Depth of filter material_Jf..' _.Total 6ngth.--..--. A" '. <br /> Seepage Pit. Distance to well.. Distance from foundation-..-----.-Distance to nearest lot line.-.- <br /> 0 Number of pits._-._.___----------Lining material....--_...............Size: Diameter----!.................Dep1h--------_-------------- <br /> Cesspool: Distance from nearest well_-_'.........Distance fr&n material............... <br /> in.................___Uq.*uid Capacity---------------- <br /> Size: Diameter-------------------------------------- Depth.......................... <br /> U S - .11--- 4. .0. 1 <br /> Privy: Distance from nearest well.........................................^: -Distance from nearest building ............... <br /> 0 Distance to nearest lot line........................................................ -------------------------­­;:­..........------------------------ <br /> 0 ............................ <br /> RemodeliIig and/or repairing (describe):.......-­------------------------------------ <br /> ..................................................----..............................•---...__....__---- <br /> .................. .......................................... <br /> --------- ...... <br /> --- . .............------------------------. ........... -- 7T% <br /> ...........---------_------------------------- .........------------------------------------ ­......................... -------- -------------------------- <br /> I horoby certify That I have prepared this application and that the work VIR be dow.L-1 occordenco with Son -100CIILlin County <br /> orencn=% Sfeto lows. and ndees cnd regulations of the San Joaquin Local HoaK Disl`ric- <br /> and/or Confroctor) <br /> -------------fn&�-------------�Ornact <br /> ----------*....... <br /> . . ............................................................... <br /> (plot*ft, Aoti*CM tizo of lot, bcc*on of sysicm in rotation to walls. bulldings, efc, can bo placed on reverse zldoff. <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. <br /> •----•------------ --------- ----------,- _ DAT _A--- - -•-------•-•----••------------ <br /> - <br /> ----------------------------- <br /> _ DATE-----------------------------------------......... <br /> REVIEWEDBy------------------ - ---------------I----I---1-1------------ <br /> BUILDING PERMIT ISSUED-----------...............................................•-- <br /> .............•...--_.._____ ------------- <br /> Abierctiom crid/or rcc*m:---­tndtbtia=------------------_----------.................................................................................................. <br /> .......................................................................................................................................................................................... <br /> ........------------­--­------.............. <br /> ................................................................................................................... ............................. ..................................... <br /> ................................................. .........................................................................---------------------------------------------- ------------- <br /> ............................................... <br /> ..................................................................................................................................................... <br /> FINAL INSPECTION -------------------- <br /> SAN JOA9UIN LOCAL tiZALTH DISTRICT <br /> Street <br /> 120 South Amwkcn Strom 300 WCO O*k Strom 134 Sycoviero Strom 205 West M <br /> Irrecy.ca"flornic <br /> canternic Lodi,ColOwn <br /> ES 9 REVISED a.5100 2M 5-62 ATLAU <br />