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ur . <br /> ^~ zw = <br /> / /10APPLICATION -F6R' fANITAT]ON PERMIT Permit � <br /> (Complete in <br /> Duplicate)' Date 600e6 <br /> Application is hereby,made to the San Joaquin Local Health Districtfor a permit and installthe work herein dwocr1kwd <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-4A87 <br />. Con+roctor', Name---- -­----�--�-------------------------------------------------------........... ----------- Phone................................... <br /> Installation wResidence ��' Aperhnenf H [] Commercial [] Trailer Court <br /> Number of living units: __;Z� Number of bedrooms J... Number of baths �2_ Lot size -7W.ai;Va.Z-x------- <br /> Water Supply: Public system Dr-'Community system E] Private [:] Depth TO Water Table _/1-eft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy 'Loam E] Clay Loam <br /> ~~~' [] -- -- __ <br /> PreviApplicationuwApplicationMade: (If ves'6uto------..> No @� New Construction: Yes Er' No [] FHA/VA. Yo* [] N6'*=p-- <br /> TYPE Of INSTALLATION AND SPECIFICATIONS: ^ <br /> (No septic hxn& or cesspool permitted ifpublic sewer isavailable within 200 feet.) <br />� <br /> Septic Tank: � Distance from nearest we}L���--.-Diotunce from 6,unduGon'j/�-/----��atoriuL/ <br /> No. ofcompartments------------7---------Size...'���'-/-�'(2--Liquid 6op�h-----------^m ----------Capacity- <br /> Dis Field: Distance from nounos+ . �. .D f fo 6 ' �4 � <br /> ; Number of |7nec_. Length of each line-�� ., -_--.�Width of �e"ch-.-�-_--�--.-_. <br /> � _-Tt�| �wg+ -JWP_'--__..--._Tvoe of filter --Deo+ of filter mo+e�uL.� ~ �-� <br /> \� <br /> / <br /> Seepage Ht: Distance to n=m,00 <br /> �eL' _�.��� - to <br /> -------------- <br /> Number of pMs.�~__-- Unmoter.���^.-'_ <br /> Depth_. --__- <br /> ', : Distance from noon�t *e|L--_._D�+unmafrom foundo6on---_-_-�n|ng moter�i-------_- Z5� <br /> ' 1-71 Size: Diameter---------------------- ---------------Depth --''-'''-_'---''-_''_'Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------- from nearest building--------------------------------- .....' ~�~ <br /> Distance to nearest lot |ine.'''----'''-�''-''--'''_--__-_.--_-'---''--'____'''--_-'-'-_ �~ <br /> ~ <br /> Remodelingand/or repairing :-------- --------------------------------------------------------------------_.----------------------------------- ' -----------_.-_-__ <br />� --.-'-__-_---_--.------_--_-_._---.--------.--------------.-_---_-----_-----_------- <br /> ._--___---'---___-_-_--____..-_--__---._-.__'..__..__-_-^----_-'-______--_--- <br /> --------------------------------------------------------- ---------------------------------------------------------------------------------.___._-_._._._---_-------- . <br /> have prepared �� <br /> State laws, rules ' ' �� / <br /> ~ \ . <br /> (Signed) --�--^--_--'�-----._.�O*ner and/or Contractorl <br /> N��_'___-__ - ' <br /> ' �`..- y.. (Title)~''''-'''-''--''---��----- | <br /> �� ��. �w�� �� of l� � ��o � ells, - :,efc., can he placed on reverse d6mL <br /> ' <br /> FOR DEPARTMENT USE ONLY � <br /> ' / ' / ' -'---''-'-'_-'--- <br /> REVIEWED8Y-''---_'--.--'-''-----�-''--'-_''__' ---------------------------------------------- DATE''--'--__.'-'-_.-'__--'- . <br /> BUILDING PERMIT ISSUED------------------------------ -- <br /> Alterations and/or recomm Cr. t* <br /> -''-'--'_''-'''' _'''-''--' -- '' 1--_-------------------------------------------------------------------------�---'�-' _.--''--.''__'-''-'_-.__.-'_- <br /> -`-----``------`---`--`-`--`-`--``-``---`--```-```-`---``--````-`--'-````-```-`--`----' <br /> ' � <br /> --'---'^--'-------'--'----'--'-''-''---'--''--''-- c-''----'---'''-'''--'--'-'-'---' <br /> � <br /> FlNAL INSPECTION 8Y:./�I�� '��������---._-'- ' Date -1, <br /> ''-''-'-'--''-' <br /> , . ^ <br /> ' <br /> / SAN JOA��0N LOCAL HEALTH DISTRICT <br /> / ' <br /> 1�/��°�S� ' �W��n� `���o� u���o� <br /> Stockton,California Lodi,California Manteca,California TraCYr Calnornl' <br /> cw 9 Rs,/xco 8'59 uM 5'd52 ^,L^s ' �^ <br />