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<br /> APPLICATION FOR ANITATION nitw Permit No. . A4--P = �
<br /> ° {Complete in DupGcafeJ
<br /> _- This Permit Ex iras 1 Year FromDate Issued Deft Imied - -4`-4 `r
<br /> �'nhv -ads to th9 San Joaquin Local Health
<br /> District for a permit M construct and install
<br /> I made in comp„encs with County Ordinance No. 549. �Y
<br /> l ...........................
<br /> '•
<br /> =:c
<br /> AND LOCATION.... �
<br /> / ?”
<br /> l
<br /> - ... .-...---••--•-•---....».....»............._....:Phone '
<br /> {
<br /> - ^ Wilt serve. Residence ❑ Apartment Hou ❑ Commercial ❑ Trailer Court ❑ Mofel [] pfd
<br /> 13
<br /> ,,^ib@r of living units: ../... Number of bedrooms .2 Number of baths-L. Lot tag- —L
<br /> 3•a p !y P ic s stere ❑ Comm Community system
<br /> Private�pth to Wate '—• r•
<br /> .fi
<br /> E
<br /> Table �iP ft.
<br /> a r of soil to a depth of 3 feet; Sand 0 Gravel ❑ Sandy loamlay Loam �
<br /> ❑ /�ley Adobe rdpen'Q . '•
<br /> Arplication Made: (if yes.date.......... .........) No
<br /> New Construction:.yes(Jc}-No © FHq/VAe Yes[3 „s,f+to 13'
<br /> OF INSTALLATION AND SPECIFICATIONS:
<br /> `PJo septic tank or cesspool permitted if pubBc sewer n areabe within L I
<br /> 200 fief.).:/ -; ��+►;
<br /> Distance from nearest well_...�� p--Distance from f�wndaon» Q_ M�te,,�I. -r��T� o �,� •
<br /> No. of compartments.........-.7. .:.......Si:e, .;xT uid de
<br /> F,c`d: Distance from neewell-..,C!?/ ^
<br /> rest ---.Distance / •�•�:' '.•
<br /> from founds ' O 4 :
<br /> Number of lines.................Z-r..--........-Length of each line.»_t Dittanoe to ntetest lot
<br /> Width of franch. 7.�...
<br /> t
<br /> Tyne of filter materiel•/ ',t�d r..-•Depth of filter material...,.. - �r Total
<br /> Distance to nearest well.....................Distance from foemdefion ,.. .Distance to jse:ji{ks}rme„�
<br /> Number of pits......................Lining material.
<br /> ........Sae: D;ambter
<br /> Distance from nearest well...........- Distance from fou ~
<br /> ng materia
<br /> ..... r►datTon._.__...;.._..__Gni .
<br /> Sire: Diameter......................................Depth..... Cap".,.
<br /> ........---•'..
<br /> Distance from nearest well......................... .......... Distance from.nearest building-'..,.'.
<br /> Distance to nearest lot line.........
<br /> 7 m
<br /> and/or repairing rdescribeJ:............. 't�� t/ _yv *, ;� :`
<br />................!•„'•-_:--•... ............-_......._�..... _._.... .___......• r �`4 µ+.'_ ~T l � x •. '
<br />..............................».................--._......................--...---... -_.-..........� •..�............. ,•.,,,.:' _ ,:N -:h _nR !
<br />..---'�hereby••eer��fy +I,eF l IlaYe._......».�......�_._...»....__..... .�. -�_ .... ,,�;,,,, „•,...".....�..�.3Y�..... a.. ..`� ..,��s °�i+�E h. r .,� �
<br /> wdinaneat, ate P`�a'ed is apPl'icafion end f6o flee Work w�be
<br /> St laws, ro nd lions of the San +000rdewoe irHlt Slit.hlegii i
<br /> fiq>•Ad]..: ... ............ .... '1°a4utn..oeaf F!leeNls Dirset -.A rTV
<br /> ' .
<br /> aq <
<br /> BY., ---......... ...........,.....� ...w»....»»-.. ....jOw11a►Mtd/er canfn.aterJ � �� .v
<br /> tot plea, :hawing ser of�} `.... ......... .._............__.........._.... ' ...: ._. {1 ;,,,. ' ............:... R
<br /> loeatlen of In relafien to vreN4 +'t
<br /> �•k,can(sr pfrped err` se�} ,.r•' t � �, rr.
<br /> FOR DEPARTM USE ONLY i .a
<br /> PPLICATION ACCEPTED BY......... ...
<br /> EVIEWED BY. r
<br /> DATE .`l._ lr ..1 .,
<br /> ... � ......
<br /> ......................................................... DATE:'•'.
<br /> .......
<br /> JILDING PERMIT ISSUED.. ... ......... .. . - ,rw
<br /> her:.+ions and/or recomrnendat;ens:........... ......................... ....» ».. ,.. ...... DhTE _ ...........». :
<br /> .....
<br /> ...... .... ............................................... .........................................._.• .... ... .......'.»..... ..............._.....«.......
<br /> ....
<br />-l,`,jAL [NSPECTION BY
<br /> n
<br /> ............... Dat+.............. .....:/ ._...................................
<br /> S JOApuIN LOCAL HEALTH D15TR=
<br /> 1 ie 5oo,h AM�ri,nn ihpM 3 Woo 081,grMf 1114
<br /> Seo.kten,Cagternle led'.eairtereiee �� C601101,1110 - >fOtoom cowrrno
<br /> "'r'•"• b R,'.p 'l.M 5.62 ATLAIS
<br /> t8 ��
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