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� <br /> FORqEFICE USE, <br /> �\ <br /> �ermif ���� <br /> �������� � Ap��AT ON FOR SAN��ION �RM� / 0 <br /> - -- <br /> (Complete ' ' bL Bm+m Issued <br /> Application is hereby made to San� a permit to construct and 'install the work herein described. <br /> This application is mudm in compliance with County Ordinance No. 549 <br /> JOB ADDRESS AND -..� <br /> Owner's Noma-_.--: �� ^ <br /> ........... <br /> Address.....................-------------------- <br /> [�^�'���--_���--_--_-. ----'--'---------------'-------' <br /> Contractor's Name-------------------------------- -.~��- -------.---_-.-_.---_.-.--. Phone...._--------------------------- <br /> Installation will <br /> -.-_---_--'|nota|la+ionwU| serve: Residence rtmontHouso [] Cnmmo,n|u| [] Trailer Court [] Motel [] Other [] <br /> Number of ||°/ng units: -_X. Number of bedrooms 5"um6er of baths ~�-- Lot size .......... ..'��.+��'^�_--.- <br /> Wmtm, Supply: Public ,yohmno [I,-Eommunitv oyvtmnn [] Private [] Depth no Water Table <br /> Character of wmU to m depth of feet: Sand [] Gravel [] Sandy Loam F]-7C|uy L6am [] Clay,[] Adobe[3 Hardpan C] <br /> Previous �p|��w��mn Made: (|fy ) No E] Now Construction: Yes ��~No ^ FHA/VA. Yes 0 Nof5- <br /> ' TYPG OF INSTALLATION AND SPEC|F|CAZONS: <br /> ` <br /> � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> . <br /> Septic Tank,/ ' Distance from nrom,i w:U-_---.-Di,tonca from <br /> fuundu+ion--.-_'.---K *tmriul---------------------------------- <br /> No. <br /> .-'- --'�'--No' of compartments, ..Gzm ' ... .---.--'--Liqui6 6 p�h--------------------------Capacity-._-----.—__'_ <br /> | <br /> Distance from nearest waL."��'Distunoa from foundation------ -.Distance to nearest lot line----- <br /> /7 <br /> --/' <br /> Nvm6o' of /in - of �n�� ||n ^ � . Width of trench ` � \A <br /> %4- pe of filter mfer�L ��� _ 'D�. of filter mm+o�ui �~� ^/-'To+v ~ -. <br /> Seepage Pit: Distance to noawell----------------------Distance from foundation_.-----.-Distance to nearest <br /> --|-�- - 41* <br /> ine <br /> 11 Number of oits-1�--------------------Lining material----------------------- Diameter'_-'-'---------Dept h.'-_-'-----'- - <br /> / Cesspool: Distance from nnum*� woL_-_-D�fwnm, from foun6uHon- --_-._-Uo�gmutaroL---_--_---- <br /> [] Size: Diameter-!.---_-'_-'_Doo+ _-_-..__-_--___�o�d Cu9m�ty'_-'____-ga|� ~ <br /> Privy: Distance from /nearest well------- Distance from <br /> [] Distance to nearest' <br /> ` ( <br /> ��I�� -���_. <br />| '--' certify 'hat- ' have , / <br /> ordinances,^ ~'~'= laws, ""� Health ��rn�r \ <br />| ��� -- ---`-- ---- ' ' ' <br />� -----------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:---_'------. ----------------------------------- ------------------------------------------------------------------Title)-------- ------------------------------- <br />| (Plot plan. showing-size of lot. location of system in elation to wells, buildings, etc.. can be placed_ on reverse side). <br /> �OADEPARTMENT USE ONLY <br /> ArruCn./uN ACCEPTED ur-----�--^^� ''---_''''_-''-_-- DATE'-'-,�~�-��~~�/�~-��'---'' <br />, REV|GVYBD BY.----------_.-.�,--'�~---------------- ------------------------ DATE ----/'-'--'''^-'—'------'' <br /> BUILDING PERMIT ISSUED------------ DATE----------- --_--.----.___- <br /> AMer*+ionuand/or recommendations:---------------. ----------------------- <br /> --------------------- <br /> .--.-_.-- <br /> '_---._-_-------------_-�-�'���`'- +_.. _ _-_--__..__._''-_ <br /> --'-'-''_''_-''_--'-_--'''�-'--'��'���'-''--'�� ' '' -------------------------- ----------------------------------------------------- <br /> ----------------------------------'--'-'''-_!'-'''-''---'--���_�_. ____________________________________ <br /> - - . <br /> -------------- ---------------- ............. ----------------- _ ------------ '''-'''-'''--'---'''''---''--'_--.-''--'-''-'--. <br /> \ <br /> RNAL INSPECTION 8Y---------------- <br /> ----------- Date----- <br /> ----- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street ^ 300 West Oak Street ouSycamore Street 20oWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES p ncv/ssn ^'or ow n'az »`Lxa � <br />