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� APPLICATION �� Pe;m� N� - . ~ ---- �� . \J- --''--�` Do+n |ommJ -----. plicafion is hereby mode to the Sun Joaquin Local Health District for u permit to construct and in�oU the work herein described. This application is made in compliance with County Ordinance N 549 ' � � ' ----___---_.--__—__ Owner's Name' � ________ phone______________. - � � ��'�� Con+racfor's Name.--_�� .� �---._- Phone----------------------------------- Installation ._—_--._--- |�� | serve: Residence ��a� House E] �mme��| E] Trailer Court 0 Motel | 0 Other E]Num6a, ofUving unit`: __/... Number of bedrooms Number of bu+k` —/' Lot size // ------------------------------ Wafer .----- ----- W�o Supply: Public system mmu�� system m � Private [] Depth to Wafer Table � Character of soil to o depth of 3 feet. Sand [-] Gravel [] Sandy Loam [ Clay Loam [] Clay E] \6 o6n a~"Hu, 6nan [ Previous Application Made. Yes 0 No 9�~-No. Construction: Ye, [] No �HA/VA. Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: (N* septic tank o,ceosp**| po,mYtfoJ if public sewer is *°wOablew�hin 200 feet.) eptic k Distance from nearest woU--'----Distance from foundation-------MnturioL-',-----------_----._ Nn` of compo�mnnt�------._S�o_---'___._Uquid 6ep�h—__.---.—.Capad��._'—''_— 6: Distance from nearest well------------------ from foundation--------------------Distance to nearest lot line —''' Number of lines-----------------------------------Length of each line-------------------------------Width of trench----------------------------------- Type .--._— --Typo of filter material-------------------------Depth of filter material----------------------- | '—'--'—'---_''— � / , ^� Distance +o nearest to |o+ |i /V " |. � � � nearest �Num6er of p�t�—.. �----.L�ning mutu,iuL. ��.S�� umof�c-��—��Dop|�—� � —��--- Cos'po Distance from nearest well .—._--Distancufrom foundation-------------------- m°tn,oL--.___—__ [] Size: Diameter----- --_'-_''—''''D�pf6-''''---__'-''--''''--L�uid Capucit�—'—_.'---_—g�� . ` Privy: D�f nco from nearest-~vU--''—'_''—''''—'''''—Disf nce from nearest building---------------------------------- ----� n D7stance to nearest |o+ line----------— --.. --.. d�lii n g escribe - - --� - _'--_--'—_.'—'_-- _ ---_--=�—�_ `~= -'_-----''—'—''—_—''_—'---'—'--�_--'— ^—^-----+°—'------------'�------''�--''--''Y"—^='-----'---'-----------------------' —'—''—'--'''---'---'--''--'--''---'''---'----'----------'------------''--'-------'--'—'--''—' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,Uand r les. and regulatiops; of the San Joaquin Loca�IHe' 11fk District. -- By: ' (Plot plan, showing size of lot c- ation oi system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY . . .\pPUCAT|DN ACCEPTED REY|E *ED BY''�''—_.''-- - — ''--'---''--_--''''---_-'- -- D/ E' i BUILDING PERMIT |33UE[1----��._'---_._----._---___----��_. DATE_-��------- ---.--._____ � Alterations n6/n, ------------------------------------------------ —' tJ '------------' '' -------~^--~-----m-----'r--'-----__ _____ '--'--------'''�r---- --7�--'��----------'---'-----'-----'--'—'------'------'' '—'_----'--'''''''— �_. --------- '—_'''''— ---------- '--''-'_—'_—'''---'--'--'-- . F|N/\L INSPECTION 8Y:.- '----------- �Date----- ------------------------------------- � SAN JOAQ0N LOCAL HEALTH DISTRICT /m South American e=°^ 300 West Oak Street oz Syc^m"rs Street 814 North ''C^ s*=°t . Stockton, California Lodi, California ^x°nte"=. California nram/, California ES-9-2M x".is"" 1'57 r.poz.