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V Applioa+ion is hereby made`to the San .,oaquirn Loca 'Health District for a permit to construct and install the work herein described. This application is made in compliance with County:Or inance No. 549. + ` a ., f @,ter ��..y y�/}� A O 1'-�• ( _ _-'3-- 1------------------------ ---------------- JOB ApDRESSJ AND L CATION_ -- � - r e Owners Name {1 _� --------- 1 C r __ l •�_�J r �y P,i, - 2. ------ � ------------------------------------------- one. - •- yy Other _ Contractor s .Name__.-,�-U- ---`�•�=� - P �-__�rZ� � I Installation will serve: Residence Apartment Hausa ❑ Commercial ❑ ,Trai r-Court ❑ Mote! ❑ O ❑ St Number of living-units: _ Num i f bedrooms .- Number of baths Lot size ,f# / / �^ g _ o_ bee o i b Water Supply: Public system ❑ Community.system ❑ Private epth to Water Ta e ' Character of soil to a depth of 3 feet: .Sand.❑ Gravel [I Sandy Loam El Clay Loam Clay [I Adobe ,Har;dpan Previous Application Made: Yes El No NNew Construction: Yes El No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted ublic sewer is available within 244feet.)7.14 IL" 1Ma et rias_ u P. p p .�;. J,.. .. ,. - S Distance from nearest'well 1'__. .___. ..__Distance from foundation_.___ ----- - Capacity . No of'cornpartments _., Size.------ Liquid depth .__-- ----- ' ' _ .Distance to nearest lot lm -------------- osa Distance from nearest:well .......:.......Distance from foundation_.--_-_----- Width of trench.._________. -_ z� I I � t_ Length of each line---- Type of filter g -------•---- Number of ° er material�_� ..-.-Depth of filter material.___.____ Total length.._..___: i See * r k I i .Dist nce to nearest lot lin6 - Distance to nearest well;: . .._ ____Distant rom f un 5ize:nDiar< er__>p �_ ------- ------ --- •--- " Number of`pits.--:1------- -�--Lining material- -. --- Cesspool: Distance from nearest well -.--_Distance from foundation.... ._.. ._:___ - .Lining material__._. _.. ----------- ---.De th------------------------ ----- --- N4- Liquid Capacity ------ k-------gals. y S;ze:`DiamBter--------- ---- t I------------ Distance - -- P f ❑ l° 1 k to ce from nearest i -- - ---- -- 9 '---- ----------- --------------- -------- Privy: D s n f R g ^ arest bu"Id•n Distance from nearest wel�_ % .;I ' .;. "Distance to nearest loft Tri------ ------------------- --- -- ------------------•----•----•----- = I'❑ „k - �_______________ -�__� _._ Remodeling and/or repairing (describe}:'._._.._,_._.______---------------------------------- ` r -------------- ------------------------------ --------------------------------- ' r: ----- - - __ -- --- _-- E --------------- ------•------------- ---------------------------------------prepared I i- pp 1 hereby certify that l have this application and that the work will be done in accordance with San Joa uNn County ordinances, State laws, and rye Yn& re I Nf a13 T s--of the San Joaquin Local Health District. F .. r 1G I y ntrac# 1�f�S&plEldo acro N �1-7r614B - ---- - Title �� - � •! }.! , orj Ss ned rvEce 1. r�C. ( ;g � f1 ---._Stocktanr-f:nhf- ----------- "buildin , etc- can be placed-on reverse side).'. (Plot plan, showing sib of lot, location of�syslem in relit' to wells, .FOR DEPARTMENT USE ONLY _ - ---------------- APPLICATION ACCEPTED BY_.__...-.___.__� DATE---. -- } 1 DATE ---------------------- REVIEWED BY..............---1------------------- - - DATE------------------------- - '{ BUILDING PERMIT ISSUED-------------- ----- -- " Iterations and/or.recommendations:..-.__-. .�. --- '4 t --- - - ----------------•------ -----•_---" -;--- ---- j# -------- ------ ------- ------------ "k ------ ---'--------------- ---- ---- 4 o- 1 -• -- -- - -- - Date I FINAL INSPECTION BY: -------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT ' i 132 Sycamore Street 814 North "C" Street 300 West Oak Street Y 130 South American Street Tracy, California Stockton, California Lodi, California Manteca,"Celiforaie Y - 1 :/ 2M r+9r149446 ATWOOO 12.54