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~�41 °- u, APPLICATION FOR S�^�� ��T� �� PERMIT n�~-��~ ,, ^, ' _ (Complete in Duplicate) 11 work� h - | /hu S49 ! �� ' ~° � } �r� ~ / J[`G /\DDRESS Bo�___16_3-_G_ �------------------------------------ C^wner's Name-------------- W�,2jpr-Y.ise-''__--'-'''''�-'''''''-''''��'''''''--'-�'_-. Phone' Addnass. Rt Box 163-G -- ' 1`44e ` '---''----�------''''-'-----''--'^'-''''�-'---''-- Confn,c+nrs N�nfe.-_]3eIta--'-_---.--_---------------------.-------_-,--.. Phone----3 _.--_.. -- |noh,|latimn will serve: Residence Apartment House [] Commercial [-] Trailer Court 0 Motel [] C*kor E] Number of living units.- 'M Number of bedrooms EIL Num6o� of baths Ej Lot size-------e4;--_acre--------_---.- Water Supply: Public system E] Community system F] Privafe�Cj ' ~ Character of m,l| to a depth of 3 feet: Sand [2 G,ave|'-E] -Sandy Loom E]--Clay L8am'E]- C|-mFYl-=�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No ��p+i� tank or cesspool permitted � public sewer is available within 200 feet.) ' Septic Tank: Distance from nearest .�U��T��-anE�-fk4ato�o| (� ---_--_� No.-of cnmpurtmunis-------2------ --.Cupocity---8(][l--,_3ize___4_'.x _r----~-Uqu@ �depfhi_&3_,1------------ Cesspool: Distance from nearest well----------- --Dstonoafrom foundo+inn------------------Uni"g material '_------._-- [] Size: Diameter '-'-'-��'''--_'-Dao+ �''�''-__-_'''��-''---''- pri"y: Distance from nearest well-------------------------------------------------Distance from neo ' yf building--------__�---^- L1 Distance to nearest lot |ine` _-----^-____.. �� | Seepage Pit: Distance to nearest well-__-''''.'Distance from fo 'undufioz_.---.-Distance fo nearest lot |ine. --------- | [] Number ofp|��-_�''''_Un|ng material----------------------- Diameter -___-_-_-Depth '''''-'_- ----------- � Dinposa1 Field: Distance from-nearest U �50` ,Distance ' Distance to nearest lot |;nn-�� Number of Un Lengthvfo8ch |in » Width of �anc6..��!----'---------- Type -' � TypoufGlte, moterioL=ok_.-Deothoffi|termofo,iuL-��-18u__ Remodeling and/or repairing (descrbe)---------------- -e-M--------------------------------- -._-.._�.--_____--_______. � -------------------------------------------------------- ------------------------------------------ --------------------------------------------- ------------------------------------------------------------------------- - '-r''----------'---'-----:'--------------''----''--''�-7-_--_��.-_---________`_�_______. � ---__--_-_'��--_--.__._--_--_-----'^-_ ----------------------------------- . I hereby certify that I have prepared this application and tha+;'the w,ork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin.Local Health District. I I (Plot'^plans, showing size of ' � ''--' - --- - '-- buildings,—' ~~~ ^'~~' ~~^=" ~"""his"pp'ca""" ' ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DY------------------- ----- ----------- `-- -_-----��'- DATE'�'''- REV|EWED'BY �sC-6- ___�� _________��_''_ D�TE_ ''--+BU|LD|NGISSUED v` PERMIT -------'---�-------_�---------------__----. -_-----.--_---_____ Alterations and/or recommendations:------------------------------------------- ------- ----------------------------------------------------------______._______ �_ / '''''--'--'-'�'`'-_.-'''''''___�'''''''''-'-�--_'--'''''��__-'-__-_-_------_-___.--�--.. ^°° ''---'- -----------------------------_.----'''-'-____' --..^~-'_--.''''�--.--��'��'''-'---.`'.� .�'' -e__ ' ^ -----�_--._�—. . � --------------------------------------------------------------- -'-''�_'' '--'----'---�^''''-- ---''--'--'- ---_—_'_-----____-_- ---- ----.__-_'��_-----__-_--._ --'�---''_.. PERMIT N � ��--|��UE� ~~ ' --� '-�''�� - (Dofe) RN/\L INSPECTION BY:----- -------------------------------------------�---__ � Dmte----_-_----._--.._`______�__._ | - SAN[JOAQU/N LOCAL HEALTH DISTRICT , 130 South American S+nynf Stockton, California ES-9-2M 9-50 W-1639 -