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FOR OFFICE USE:
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<br /> � 1/4 "� . . .. ,.. � �U APPLICATION FOR 5ANUTA110N PERAtiri Per►nIt No. ...:,� ` ry • ._
<br /> _ (Colmplcdge in i�aJili4e�t+sy .. �.. "
<br /> This permit Fxpir s 7 Y4ai From Dete Imod Data Iscuad
<br /> A-pplication is hereby maoo to the San Joaquin Local i-ipaitl; District for a perrrit to construct and insftli the w0A hCrOin dt-tcn1o:i
<br /> This application is made in compliance with County Grd;,)anco No. 549.
<br /> JOB ADDRESS AND LOCATION............ ... ..............................,........:.............I.........
<br /> ........,.......... ...... .._._
<br /> ' nfir's €Name........)- ........ .. .+ .. ............5�. !?!1.. 1"n...� ..,.. .., ..................................... Plea......... .,........� y
<br /> ddross....................3wc........ .LT..A,........ g ............ ..
<br /> .....,.,.....,........... . .s
<br /> .e .. 5 :.{a..a:.�r�. .....:................ .......,..«............. r
<br /> 'contractor's Name.........�.>".r...sr.s.�-i.. ..o"t:......:J
<br /> .t..tiF.!..�.s✓.......�.�r.!f"s...................................
<br /> Installation will sorvo: Residence p Apartment House 0 Commercial Trailer Court ej MOW 0 Other [3 ti
<br /> Number of living units: ........ Numbor of badroomc ........ Numbvr of baths ........ Lot sizo ...... ` .......... .....
<br /> Water Supply: Public sys+omP� Community syston; 2] Privow 0 Dopth to Wafer rabla .AP. ft.
<br /> �j Charactor of soil to a dopfh of 3 foot: Sand ❑ Gravol o Sandy l oam o Clay Loam u Clay V AdobeIwla-dpw 0 s t
<br /> Previous Application Made: (If yes,dote.. . . . 1 No�►'� Now Construct;w. Yes [I No � FKA/Vk Yes NO;
<br /> TYPE OF INSTALLATION ION AND SPECIFICATIONS. v k
<br /> (iso septic Conk or cssspool pormi#ed if public sower is avalial.,�lo within 200-Km- t-)
<br /> Septic Tank- Distance from nearest wet].................Distance rrosfour,44t;o.....................Material.............
<br /> 0 , _ No. of compartments.... ........ .... ..... Capacity—........ �
<br /> uis osal Fial Distance from nearest well �,ta3cv from ioundation_.,I 0........,,..Distanco to nearest lot .
<br /> II ..ra.ir......-{7.r
<br /> l t (.............. ....l..ena+h of"c% Ine.........5. Width of+ranch.,.. . .............
<br /> #�1tyn1D6r Ot lines-... ' ; k• �r Al."
<br /> C4 Ad Typo of filler ma+arial.,.S..PncX..Guptn of filter nvatetviel...._�.�'.`.......-Tota€ lin ......................3.C1�.. .�.
<br /> i Seepage Pity Distance to nearest s,eii.....1 ck.0.}......01'%tancu from fo:snofat or...:..A,L?.......Di•s�ante to nearest lot lino...-.+9.:..r r
<br /> £ "'� numbor of pi+s.......-I. Lining matFsrisl. ..d��i'r.lt .5'.:0: DiornotL:r.,....,` t.7Doptls .
<br /> 4 Cesspool. Distance from nearest woll.................C)4W-lC* fram fcandAf7on. ...,,,,..,,. „ Lining matwief............................
<br /> .......
<br /> 0 S;,-e. Diometor...... ..... . ,Liquid Capacity. g � ' I
<br /> tr 9
<br />;s Privy: _ Distnnco from ncarest well ... ... .... ....._....-...,. , . ....... _D;Sfd6C0 from nQare;-s+ buiic3ing ,...............- ..................._
<br /> ❑ Distance to no-rest lot lino ..... ......... .... ... ..... ....... ........................................................_,....................................
<br /> Remodeling and/or ropairing (cI©ece'vu}: d ::a �.,. .'.L.l,s.'} i zt...5: :w. .._....... .....................:............ ..
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<br /> Ir .... ........................... .....,.,.•............... -.
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<br /> € hereisy cer+ify tW I havo prepzr:,,,J s eppl Wtiols 'rnfj A&?tom wr 'e wig be done in Accor anco wA Sane Joaquin County ,•
<br /> ordinances, State hews, and ru€ef, and ref fide= &ser Jos Ruin Local S t'naRh District.
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<br /> Owam arsd or Contractor
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<br /> ....:4,.... ...3 .. .,... ...... ............._..-........ --•• --.. lila ..........-...... .-..
<br /> (Plot plans, showing stzo of lof, location f s}s4ern
<br /> in
<br /> reidtietn to wolh, bull dings, a+c„ can be placed on reverse side).
<br /> — ---- - FOR MeARTIVENT USE ONLY '
<br /> APPLICATION ACCEPTEDBY.-. .� ;;���. . ................ DATE
<br /> ......�r� ��...
<br /> RE`dIEWED Ey... . .................. :... ... .........................--...... DATE...... ......-.._.......-.....--.......................
<br /> BUILDING PERMIT ISSUED................... ri_ -. �f4ft:..... .........:. ........................................... ..,�
<br /> Attere.•lons and/or recommondations.. �. ✓ -...�r ... .. f r........................................
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<br /> FINAL INS�KytOtZ BY: .01
<br /> SAN JOAQU;;.1 LOCAL HEALTH DISTRICT
<br /> 4601 &.inarelfan Ave. 100 Was'Ooh Sfraet 374 Syrornore'$7reel 20$Wwl 9th$lreel r
<br /> Srodlae,California Lad.,ealir*e ;a Ma-.46'California Tracy,California
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