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<br /> �s ................ ... .......... APPLICATION FOR IMITATION,PERMR Psnmlt t+1�t � .
<br /> (Complete
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<br /> This Permit Expires 1 Yoar�Fmm 0 Iswed '
<br /> Application is hereby made to'the San Joaquin Local H.,�!11 ." `
<br /> a District fore permit tli censtruct'. dl�fi,sfnl!the work harem "bed
<br /> This application is made in coin ""rice with County Ordinance No. 549. n'';
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<br /> JOB ,ADDRESS AND L TN........[.... . r.
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<br /> } -Owner's Name_ ..---...... O;............. "4 L= PAdnsf'j;. ._..�
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<br /> "�'�i Address--.-...„..... 2.2
<br /> �_1.,+.,� � �- ~ � �.d ........_ __.I....... 4 I �4.,.��•.?�. � , r.,�,i�?,��t �..'
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<br /> _fContractor's Name.._.G!_Uij1�EJ� Phone'}r. ,. ,;
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<br /> -Installation Mill serve- Residene�e�Fartment House Commercial Troile' _. 0” ` #
<br /> ❑ ❑ Court Motel yz Other,❑4 _ s
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<br /> 10,
<br /> Nvn leer o living unih: ..�..... N�ir'bor of bedrooms,.... Number of baths../.. Lot.fae JCFi.E14G ,r. r
<br /> Water Suppiy: Public system ❑ Community system ❑ Private�epth•to Water'Tabb
<br /> CRa eater of sjii to a depth of 3 feet: Sind[N—Gravel❑ Sandy Loam❑ Gar Loam❑: Gay❑ `Adobe❑ Hardpan
<br /> #,1'revrolrs Applii.aticn Made. llf yes,dote.................. .) Nokr� New-Construction:+.Yes �' No ['�FhfA/VAs Y6s❑” N l
<br /> wTYPE OF INSTALLATION AND SPECIFICATIONS:
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<br /> 4 { P spool pernn'ItMd if public sewer is avallab�wwtn 200 feet M 1 ,,x q� !'
<br /> No septic tank or cesspool 1
<br /> S00c T k: Distance from nearest well...S.a....Distan� from foundation Ma l..Cb+ CE•T� #fir a
<br /> No. of compartments......'Z.r............Sixe...YJCAOA!57Liquid depth: �7C.r_.:Cepeci�yT��� ��;�•
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<br /> lbosposal Field. Distance from nearest well...5G7_....Distance from foundation.. f Distartos to neem Iot lass `J
<br /> Number of lines.........I. ... Length of each line ....fit 0 r •Width of trench{
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<br /> Type of filter material,., Q,. k.-_Depth of filFer rdatericrl
<br /> Tata!
<br /> ` Seepage Pit: Distance to nearest well......................Distance from %undetion .:,,.�Dlstance to r Barest lot hr�e
<br /> Y :13t`Eumber of pias............:''.,.....Lining material.........
<br /> ;Cess Distance from nearest well from from fcunclat�on' r
<br /> Pool U matenat
<br /> 5izo: Diameter....................................Depth. ,.et ... l L'Iquid Cepaaty, £ gals," 1
<br /> Prldy:' rDist,,ence from rearest well...................... ........ ;,_ , Distance from nearest bullding aF '
<br /> J �, Distance to 9'earest lot line......... .. ..................... f
<br /> ' iRe�m5odeling and/or r";rina (describe):.....AD 1]1.T.-0-N. -.. 'r70t _..5�!� �� , ;; r {£�{��y■}�' ����'��"`:. ..'�i���.
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<br /> ! hereb certify that i have prepakael vt Waipplirnik n and that flee=wort '�ii(I b �derfe t` R'San Y l
<br /> ordir►an State lowg of the San Joaquin Local MaaNh Dlstrlel. kt'i '2s:C t T 'h � .
<br /> Y: fiIrrKai + - s...................... (fOrr'rN r a Cal ac+or� i
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<br /> it. slowing size of lot,location of rystem in rotation to wells` buNd'atigr etc., can�be �� on"_4ra+le r{ x
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<br /> FOR DEPARTMENT USE ONLY
<br /> F. APPLICATION ACCEPTED BY...... �r.t���............................ �J. r 4.
<br /> REVIEWEDBY........................... ................................................................. ..
<br /> 1-,'BUILDING PERMIT ISSUED........................... ..................... . . '... bATE. ► .. #' "
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<br /> r Alteration:end/or reeomniandalian: "
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<br /> s FINAL INSPECT-1 J �f Date.,:.... �� y • i� r
<br /> SAN JOAOUIN LOCAL HEALTH D15TRIC1`
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