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. ° <br /> � �.0Wal��s1 <br /> ^e .. .- <br /> ` ----- Permit No. <br /> � FOR PERMIT' - <br /> (Complete in0uo � //� �~ <br /> '--�m�- Date Issued +--' <br /> -,�.�.--' <br /> � <br /> Application is hereby made to the San Joaquin Local Haa|fhDi`t,ic+for permit to construct and install the wprk herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS ANDLOCATIONJ/_�/------- ki &)1- -_ a I q- _/ <br /> Installation will serve: Residence- <br /> ,4_ Apartment House E] Commercial E] Trailer Court E] Motel 0 Other E] <br /> Number of iiving. units: .1..... Number of bedrooms I'Number of baths J... Lot size . <br /> Water Supply. Public system E] Community system C1 Privatej&Depth to Water Ta At. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel F] Sandy Loam E] Clay Loam E] Clay 0 'Aclobe B` -Harclpan 0 <br /> Previous Application Made: (If yes,date----------- --------) No E] New Construction: Yes E] No 2-- FHA/VA-. Yes No E:1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> /N septic tank or cesspool '' rm�tmd if pv6|yc sewer is available within 200 feet.) <br /> Distance from nu,es+ we|L-_---.-Di�unce from foundation----_ <br /> .-_-Wm+eriuL-.-------_----..-.- <br /> | No. o{ conpanmontu------_-�-S|zo-----_-.---._-�qui6 dop� <br /> h-_.------..Cupuc|t ....................... <br /> � Distance | Distance from +u� u*+ 1 <br /> � � <br /> Number of |i^~~ - Length of each v /o,n or nnocn <br /> -� W' <br /> � � - ''4 <br /> Depth of G|+or mu+e,ioL-. � -_Tmtu| length--��0' . ' <br /> Type of filter ,4o+eri �� <br /> ' <br /> Seepage Pit: Distance to nearest <br /> � <br /> weU----_--..Distunue from foundation--------------------Distance to nearest lot line'-.... -------- <br /> Number of p <br /> ------Num6o, of . ------------------------Lining material----------------------- Diameter -'_—--------Dept h---_'--.-_' <br /> | � <br /> Cesspool: Distance from <br /> i |nearest we|L-'-_-'-D��nce �om foun6u�vn-'''''''-L�ing mofo,�L'-''-------'_- <br /> [ S�o� Diameter. --.--.Deoth- - . Liquid Capacity'------------------ --------- <br /> \^ <br /> ' Privy: Distance from |nearest U Distance from nearest 6ui|6lnq--'--_.--------- <br /> [] ' Distance to nuapm,f lot line--------------------------------------------------------------------- .......................... _.---_-_-__—. � <br /> Remodeling and/or �o��6� � <br /> ~ <br /> / ------.-_------.----..`~',_----.--_'----'..-----------.,----.--_-����������������� �������� ��� <br /> I hereby h ' d h application dthatfhe workwill be 6 Y r6 with San County <br /> (Signed)..- -----TXY ... ... ./j------ - - ----- ----- -------------------------_t0mRaGawl1br-Contractor) <br /> -^------��������������� �w <br /> relati <br /> v~' plan, showing ~~~ Of <br /> —' location- - of system— in --- \ . <br /> FOR D?PARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y..&2X_&.. ---------------------------------------- uA|E- _6-._Z------------------------------ <br /> REVIEWEDBY'- ------------------------------------------------------------------------------- --------------------------------------- DATE-'.--.-__-_._-.____-_-_—. <br /> 8U|LD|NG' PERM|T |66UED.~--------------------- _.'-----.''----_'---'-_-'---'__.' DATE---------------------------------_-'---__^- � <br /> Alte,ationo and/or <br /> recommendations:----------------- ------ --------:--------------------------------------------------------------------------------------------------------------' <br /> '--------------'----'--------------'----'-'---'---'-'----------- <br /> .......... ---__-----_ --F <br /> ---__/_�---�___| ---_ <br /> ------_��--__-----___-----__----- -------------------------------------- ------------------------------------------------ <br /> -------------- __ __'-'''-'_-'-',|_' - ''---_'''-'''-'-'----'--'''--'''--''--'''-'-''-'''----'-'--'' <br /> { __________________________________^__________ <br /> '-'-''--''-''----_____�'-''_ _ ------------------------------------- <br /> Date <br /> ______________ »o� � � --'---_HNAL INSPECTION 8Y:' `,_. x <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT ^ <br /> vmmSouth American Street o0wWest Oak Street 124mycw=vre Street 205 West 9th Street <br /> ' <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Eo p "mm"" °'59 2m ,'*/ ^,`^° <br />