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~~ . APPLICATION �� PERMIT Permit No. k��n�t �mC�n�m�) � ` ' '��` Date |,00ed . ' plica-�ion is hereby made to the Sun Joaquin Local Health D�+�c+fqr o permit tncon�rmt u'"6 install the wor herein described. hi | supplication is made in compliance with County Ordinance No. 5�. . J[)BADDRE�S AND LOCATION----------------- -------- Pre .--.-.-- k-�� ' Owner's Name----------------------------- ._-�.. ��.]�'.-----`-.^-,--------�Phone--.��---_-_ � Installation will serve: Residence Apartment House E] Commercial [I Trailer Court El Motel [I Other El Number of living units: i -, Nurnber of bedrooms --1-Number of 6uHs .1,- Lo* size __-- -------------------- Vater SupplyPublic sy�fe 'P4 Community system E] Private F] Depth to Water'Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] , Sandy Loam El Clay Loam 13 Clay El Adobe lk Hardpan E]. Previous--Appiicafion Made: Yes E� No X New Construction: Yes No�-K TYPE OF INSTALLATION AND SPECIFICATIONS: 2 (No septic tank or cesspool �ermiffed if public sewer is available within 200 feet.) Distance from foundat;on---- IS, No. ofcompartments----- -�_�----- ---- ------Liquid:Jopfk..^.��---------- Capacity_-x��-o----- � , Di | Ro|J: Distance6nm nearest well- �__� -Distance��om foundation -e��` ''Didnnce +onearest �t |i - ��- Number of | ' ' ine----�� ' _ french—''' Type of filter~ muter L mofn�aL--��,-Jof | �vg+ -_'---^��-__` - � ' - - � .. � � �e*pu�o Pit: 'Distance to nearest ell~'''__—'Di�unoa from foundo�on--'--_�--Distance to nu*�, lot line----------------- Number of pits---------------- -------Lining material------------ Diameter'--'.---Doot�---''-'-'''— ' ' . " ^ . . ' � O�t nco �pm �noo,es w�L---.--D�tance from foundnf��-�'��Uning mute�aL'''-�'-_'-'____ � [� Size: D�ma+er.�—_'_''— -- ----Dept —'�'_''--'''--'—�^-Uu�6 Capacity '-'- oub J - �~- Privy: 0�t n6efnom nearest wu||_'--'----''-'''--Di�unce from nearest building'''--''-__________ rw [] Distance to neJest lot |7nv .......... ...... --------------------------------------------------------------------------- Remodeling and/or mpalring ' :------ --------------------------------------------------------L'-'''__.--_''--.''----_' .......... ------------------------------------------------------------------------------------------ -------------------------------------------------------------L ---------------------------------------------------------------- ------------------ ------- --------------------------------------- ------------------------ - ------------------------------------ ''--- '__' ` . � ordinances, State laws, d rules and -regulations of the San Joaquin Local Health District. "--- ' `^ � _--_.--_ ' . ,l ' - - '---'-'-''--'''-_'''----'-__-'--''-''`...-''-'-''-'-''-'--''--''--'—' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,'can6mplaced onreverse 66o). -`` FOR DEPARTMENT U-SE ONLY APPLICATION ACCEPTED BY-------- � ' - r 8U|LO|NG PERMIT ISSUED.-_-.. ^ �- DATE��-''''--''''/J-----' ''--''-''---'''-' -'--'''-'--''-''-'---'''' � Alteru+ions and/or ,ocommeo6m+ions:---------- - -----------__--_—_--._^--_-_--__-----_—._- -------------------------------------------------------------I''_-''--'`''-'--'-'--'-'-_''_--''-''''—'''--'-_ --- i . '' '--''-------''-' iY ---_'---'_'''_----''---'''--�'�-'�---''---'--''-'''-_.'--'---''''`,-''-'^''----'''_-.'--'-- ~ _ ----------------------------------------------- ...... i____________________�___________________________________________/. -------------- �� ''-'---''-' ''-''--'-'-- FINAL INSPECTION-BY:-- '' _ Date/�k''---,�r�------l''-- ------------------------------------ SAN JOAQW|NLOCAL HEALTH DISTRICT /30 South American Stre6f | 300 West Oak Street 132 Sycamore Street u/* North "C" Street Stockton, California / Lodi, California Manteca, California Tracy, California � ' `