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<br /> FOR OFFICE USE.
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<br /> .....-........................... ............... .. Permit No.
<br /> .. APPLICAT!.^�i f-01? SANRATI��tMR
<br /> :.:.. - _..._.- ......... (Cempl*.fe•ln D,ipAca+e)
<br /> Date Issued ., .....
<br /> .........:....._-• ---.--. I This Permit aiLis I Year From Date Issued
<br /> Appiicafien is hateby made to the Sen Joao,,::-, Local Health District for a permit to construct and install the work!+urein described.
<br /> Thi appiicafion is mode in compRian:4 with County Ordinance No. 549.
<br /> Jos ADDRESS AND LCICATION.I_sK� .• ... �
<br /> Owners n � .......
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<br /> Address_.._._. _ � �.r..B.QX.......6..�'.....
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<br /> Contractor's Name... Ct1�.'1 C ... .�.._ _... ..................................................................... Phone...46�zQ�...__.
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<br /> Instail0ion will serve: Residence Apartment House ElCommercial C3 Trailer Court ❑ hotel ❑ Other ❑ a
<br /> Number of living uni'.s: .�_... Number of bedrooms 1<. Number of bati,s ./..... Lo' size °
<br /> ._..........
<br /> Water Supply. Public system ❑ Community system ❑ Private 0 Depth to Water Tibia 0$0ft _ •' -_
<br /> Character of sots M 4depth of 3 feet- Sand❑ Gravel ❑ Sandy Lo^m 0 Clay Loam❑ Cley❑ Adobe A Hardpan❑
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<br /> I No New Construction: Yes No FHA/VA:Yes C] No f� ^• '''
<br /> Previous Appl'iution Mads: (If yes,dbte... ❑
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ; r
<br /> (No septic fank or cesspool permitted if pubUc sewer is available within 200 feet.) '
<br /> Septic Tank: Distance from nearest well.................Distance from foundation............... Material.-.............
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<br /> [�ss4Wl6 No. of compartments................... Li...Size..........__..... . ........_ quid de th....................... Capacity .._—...;--
<br /> Disposal Rekf: Distance from nee- st well/�,�.....Distance from foundation.-W....—__Distance to nearest�lot
<br /> �A Length of each [;no..4Q-- Width of trench.,.-'r — ti
<br /> Number of lines J-4)_ �/ 9 r�.... ff,�,,
<br /> Type of filter material-MAM�-Depth of filter material..... . ....._Total
<br /> length_.�t
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<br /> Seepage.Pif•,,, iskitce to nearest well�'u'._..,,,Distan:e om undetion. .� _Dista�r)ce to nearest lot line. ---------
<br /> Number
<br /> �. _
<br /> Number of plh:.Cj_�......._.Lining material.. .... Size: Diameter.. ,.ter..__:._.Depth_.01S._.
<br /> r,411spooi: Mstan" from nearest well................Distance from foundation. .......... Lining material..._....
<br /> _
<br /> ❑ Size: Diameter... ....'....... ................Dept h.............. ...............:....._._:.:.:.:_Liquid• Capacity..:_
<br /> Privy: Diste .......Distance from nearest building
<br /> �+cs from nearest well........ ......... "-"-
<br /> ❑ Distance to nearest lot line........
<br /> ` /.. _..._____.........-.........._.....-._.-...-._.-._......_.............._..........._.._......__................._.._
<br /> .._............. ...........
<br /> ._.............._...._—__..___.........._._.._.._._.
<br /> ?ensodolin and/or ro irin•- describe • _.......................................__._................ . —
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<br /> ♦ I I+ereb�r mwtify fhaf a prepared this applicaf' and that the work will be done in accordance with San Joaquin Counfy
<br /> f'Ordlrtaneef. 5}a4e {awe, and ons of the Sen Joaquin local health District.
<br /> .' ....... Owner and/or Contractor)
<br /> _ , f/ ..................... . .
<br /> Sys..._.....:__ . � ..G<C.-.... ...Q'n,.. . . y..............(Title)_. ( .......::.__...._. . ---___....... �
<br /> tlsov �of lot, ioeafierl of system in nlafitxt to wells, buildings, etc, can be lila ed on reverse side). -
<br /> CFW P611, h'9 _
<br /> FO PARTMENT USE ONLY
<br /> .. DATE.......J�D
<br /> APPLICATION ACCEPTED BY_.....- _ =
<br /> _....._..._ DATE._�•. ..............___.........•REVIEWED .......
<br /> .BUILDING PERMIT ISSUED.. _..._..... ...._.5.------_----_..._-.._._.....__............._.. DATE,..
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<br /> ....... Date.... _...... _ - -
<br /> FINAL INSFLt:?ION BY:..._. .. ... X 7- �.-•-•
<br /> t J QUIN LCCAL HEALTH DISTRICT
<br /> 1601 L Ileea11 Ari. 000 were Oak Street 124 Sycamore slut los West 9th:'r«r Mf
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<br /> CelNan,ie Lail California Manteca,California "racy,Callfocnia
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