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1 x. Perm'.it o O r'
<br /> A EC - TON °FOR SANL A IQN PER:
<br /> 1.f Ll 411 w�S
<br /> "� (Complete m Duplicate) ` " �' fir
<br /> -Date Issued, yl•1
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<br /> Application is,hereby made to the.San`Joaquin1L I Healt 0.1sfrrcf fora permit to construct and`rnstall the.work herein described ``
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<br /> This application is-:made in compliance;with County Ordinan IVo 549 F r � , �` �� � *t y-11 }"
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<br /> J08 A©DRESS AND LOCATION._: ��}
<br /> t-;- tri r ,, ! i - �i ^.. -f3 as.f`�'{ ,. r ,8
<br /> �f. V. N+ Fi Ste( ,[ {.
<br /> Owner s*dame_ c Phone ; 2
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<br /> Address — !d 122. aC°k-
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<br /> Contractor's Name _ � � D r '
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<br /> tnstalla#ion w il'serve. Resid 'd6b '15 -rtment. HouseJ; r ;Cornmerclalt111A[]F tdilerw}Cou ;[� Motel Q Oth r � 3 .
<br /> ` a/ 3
<br /> # Number of living units:% f Number of bedrooms' Numb@r of baths L -slze3 y A
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<br /> _, 11
<br /> r a r g '.� �.- 8-m 4 i s °..r s L -, ky�t, f ,r� s+�-*F i v ,..�.*r;
<br /> 5u I '� Public s stem Private De th to Wafer Table . ft $� rs
<br /> Wa#er p,I 11p , s e ,I .lty system fl, E ❑ . #� � "r, .. F ::f t
<br /> Charae#erA�f toll to a;depth bf 3 feet Sand 'Gravel © Sandy Loam E]j :Clay Loam s lay:.: , Adobe. � Hardpan [-I
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<br /> Previous Apphcatron Kllade l'@s �.' ,No` x New Cotlstructron Yes. Nof .4x .r ' < t s �€ {' �
<br /> "TYPE I SlALLATION AND SPEC�FiC,ATIOQNS. L.� ,; , �:WI a ,", Q4
<br /> (No septic tank or cesspool permitted rfbhc sewer rs avarlable'w�thln 2013Feet.� , z ggg l r
<br /> r I - sem- ..;: e. t;:s.w r n E s "$ , ;'.� t fi,_ � x{ ., 7 {-
<br /> e1: r `�7a �fi fl stance ri5m rtearsst well "t i Dlstance from fM,ilda i- -s ,Ma�ter,�e _ ""_
<br /> - a".�:,.,., C4 I.ft , :No of Compartments _ -- Size Lrquld deptls Ca�pa gty ��+.y Y
<br /> Dis ante from nearest well D,Istance 3 �
<br /> Dls osail eldOlr rt .from foundatrbn Distance to nearest' of Erne r ria.
<br /> ` p� � ; �E �� umber of Imes- ij� alength of each=fine � ii}of1#ren;Ei _ — __3
<br /> r � 11
<br /> F 1. ; � Type of filter material _ be%pth of=filter mated _1- ' length
<br /> See 'I- Distance to nearest well
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<br /> p Q Distant fo ndatlon A Dlst nc� to nearest9-414
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<br /> s 1.^r - ' r _ lJmber O{ pf s � -- °Lli.mj m4jarpr 1, . SIZA Id @t@rF ,' rD�'pth F �' y�.
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<br /> Cesspool I Istance from}nearest wel! _..Distance from foundation :Llnrrig`maternal. �x.-.,.- ---- PAS 3
<br /> �, =e 1,�., - '" r g : #�'�'- vxv' e {th €_ r x - 'c f ° 'LI`'I 8 Cap�Clt�/� r•r s_v --- � p els.
<br /> Size Diameter s y
<br /> Privys f �Distance;from nearesf w@Il rx, i ` Dls'ta"nca I- In, -LLL` building h -. 4
<br /> 44 Distance to nearest lot Ilne�_ s ! � � � " ���$�
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<br /> F a x 1 sx ^s €r b4 S c r ° `Win a s
<br /> Remodeling an f Or:rep> ICI d@SGr1beJ "�_
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<br /> r lAdle by:e$rFlfy t�tetf.,14h; repared'<+kis apphycatron and.rtk'a4;+heEwork:wrli be done%In eccorda'nce wa#ii 5arh doai urn.:'Coun}"ter � '
<br /> Ordlise G@'$tat �la' nd ales a" SrQ Ula't10 '.Of till' `' � in F pcal,,,-'W9l4 is rrcV. '" ' t' q- �': 4
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<br /> Piotan r shoV.S _ i ,size of ion lo�atron ref' stem m rale ion to,w:ells, buldin s,,:etc i canybe lacedFFn revers side3 ..; }
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<br /> APPLiATlO1 ACCEPTED Bl' y , f i ' DATE _ u r «s
<br /> REVIEWi f7 Y� T _." r { ATE i �' _ � t
<br /> BUILaINO'PERMET 155UED z z DA *: �::� F -4 3 K
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<br /> SAN JOAQUIN LOCAL HEALTH bISTRIG7 � , . ,
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<br /> 130 5cufh Amancen Street' ^ 300'West Oak S+reef s q .132 SycerwKd a Sfreef 914 North C Street7. �, , r
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<br /> Stockton Gahforma Lodi Celiforn�a {' a :Menfe'ca Cahfo�nia - 7rbcy :Geliforma � � �
<br /> E5 9 8L.'51 Revised W 2J 00 1. " ' �,s�y. ' � ' r.
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