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+~YYfOR <br /> OFFICE USE- 1/14 %3'r <br /> ..............:.—......—....... ................ Permit No./ <br /> .j..,7 <br /> APPUCATION FOR SAWATiON PERMff <br /> ................. ............... 0040 Issued -f�P <br /> This permit(CVnVIiiI4W1n DUP446%j issued <br /> ExBires I Year From Date <br /> ............ ......_------ #*Wr <br /> Application is hereby made to the'San Joaqui "Losal He Rh District for a permit to construct and install ihe work herein described. <br /> Thi sappli t' - rav* inco rdilance No. $49. <br /> , ion �rn a <br /> ON ----_--------- <br /> JOF-ADDRESS ID LOCATION <br /> ....... ............................ Phone.......... ....................... <br /> Owners NamoC. <br /> / 7 ......... .......------- <br /> Addross....... .......... ... -led <br /> 14 <br /> Contractor's Na . ..... ... ........... Phone....................... <br /> Name.... .... . .... I F <br /> InsfaRn <br /> afion'Will sev;-Residence .,.Ajar+merrt.H_ouio.E:]. Commercial [I. Trailer .Courrt 0 .Mate{ ❑ Other [3 <br /> Number of living units-. __-. Number of bedrooms A.N bebaths .......... <br /> I <br /> um7,,p , to WaferTablviii-d- ft. <br /> Water Supplj: Public systim 0. Coinmunity system 0 private <br /> Character of soil to a depth of 3 feet: "Sand [] Graval[] Sandy Loam o Clay Loam o Clay.o -.Adobeo HardpanPrevious Application Made, (if yes,date....................) No [] New C6nstructi6n; Yes ryNq [] PaIVAt Yes C] No 0 <br /> -TYK40F INSTALLATION-AND'SPECIFICATIONS- t4 -,j;4 <br /> -A- ilfhlp 200-160.1 <br /> (No-septic tank or cesspool pariniffed if:Pb06-w;4r­ls availablevywip <br /> Se nk: Distance from nearest we1l1&._'._Distance from foundation--._-P-.:......mat"'ial....4. <br /> No, of compartm;afs-_71........ ............ <br /> T, f.rz. 41 <br /> nclatiop iP�f......Distance to nearest lot lin .. ...... <br /> Ois Field: Distance from nearest well_14A_Distanc, <br /> --- ---­'_h� 7 -- ------------------ <br /> I. Number of ngth'of each -_Width of trench-.-,A---*- <br /> fter material.....LT_-_........Total len ...49-!g g- <br /> Type of filter material---.t j.=.Dept"f f <br /> .- ' �_� j t -.5. 0. <br /> rice from foundation...-t.�k,...--Distanco I --- -------- <br /> So 1`36 Distance to nearest well-_11A.L-Dista' o nearest lot lin <br /> '?.3.........Do h.. ........ <br /> 8 pis Number Lining.material....S.17.......Size: Diameter....._ . pt <br /> I �!rp f AjP-�_ <br /> Cesspool: 1 Distance from nearest well.........._...Di4ance from-foundation-------------------uning material___________-.........._.......... <br /> 0 i Size, Difornafe!-------------------....... Depth.................-----•-.---------•--- -_.-Liquid Capacity-................ <br /> Privy.-' Distance from nearest well-------------I.................................Distance.from nearest building.................................I........ <br /> Distance to neatest lot..:is....__.._.__._,.-_.--.............................. ...................................... ......... <br /> Remodeling and/or repairing (t1e,*scrib ------------)------------ ................7--------- ..................................... .-•-•-------.._.._..•-•-_... <br /> ► <br /> . . ......... ..........I.............................. .------._•^.-•••.................................................... <br /> ..................... - - ------ A--------- ................................ <br /> ----------------------------- --------- ---------__•..............:.:.--_------- <br /> I hereby certify that i have proja;od this application and that the work will be dorseln accordance with San Joaquin County <br /> ordinances, M and rulvLand regDistrict. <br /> ns of the Sari joiquin Local Health Di <br /> ...... and/or Colikirador). <br /> (Signed) .............. I ..... ....... ----------- <br /> T-% <br /> ...................i..._...............^-----......-----...... <br /> (Plot plan. showing size.af lot, location *F sys�tl'ffiinre�+ n to wets, bvItCr1ra9s,.9+c-, can be placed on reverse side). <br /> FOR.DEPARTMENT USE ONLY_ <br /> APPLICATIO .........-------_­......... DATE_z..jp�.!nI�Z... . ..-•-••-................... <br /> N ACCEPTED BY.,—. ..... <br /> REVIEWEDBY--..._-------__----_---•-•-•-•---•-..... ........1.............. ------ ----•-...._..»_._........ ------- DATE................-I---_---•-----...____._.......... <br /> ............ 1- -- ------ --- <br /> BUILDING 'PERMIT ISSUED..................... ...._..---:.........._-..» .. DATF__.._-_- - - -- <br /> :------------- <br /> T_ <br /> Alterationsand/or recominandaflons::................-•---................. ---------.:..... .........•----•................------..................•-••_._...._......_.........._......._.. <br /> ....................................... ...............................­...................................................................................... ----------------------------------­­.............. <br /> ........................................................ <br /> •-----•-•..........I......­­..................................................---.•».__.............................-.._...._ <br /> -----------­---.................. ................................----------- ............. .............................................. <br /> .................................................................................................... ...... -------------.................­­-------......................... <br /> Aq� <br /> FINAL INSPECTiON BY:..... Date-,------ ...... .............. <br /> ............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 9.HaWlen Ave. 300 Woo Odk street 124 Sycamore Street 205 Won 9th$"nvi <br /> Sloskjan,Callfornfa !,veli,Callfarnla Mcar"Ca,Calftivio Tracy,callierrila <br /> M3 9 REVISSM 8'55 2M 3`62 F-F-CO, <br />