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1h e0moliance with Cavity Ord;­­ 11,44.d_, 0, affr%tt to con trvCf and install the work herein described. <br /> J11 S nance No. 549. <br /> ADDRESS AND LOCATION—— <br /> AIA........4 Owner's Name........W as- <br /> wF1 <br /> Address...................... ...... . .......--•...-..... <br /> .... ...... ..... ................ <br /> ............. ........... <br /> Contractor's Name....._..._ ............. ............... <br /> .......... <br /> Phone_ ...... <br /> - ----------- -- ------ --------- .......... <br /> its. ....... <br /> l"Sfafta#'o` will serve: Residence Apartment House ❑ Ccrnmercial C1 Trailer Ccjrf 0 Motel [-j Other <br /> Number of (;Vin g unZ Number of bed,,,,,m, Number of I <br /> Wafer Supply: Publics ystem Ej Commur )a`hsQL Lot size._...., za—;ty systen F <br /> _] Priva feg ....... <br /> Character of soil to a depth of 3 feet: Sand [I Grave! ❑ Sandy Loam PQ Clay Loampo Clay r] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ Adobe 0 Hardpan <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wo,11... ..... ..... <br /> ❑ -Distance from foundation....-,• <br /> No. Of cOmpartmorifs...... ............. ....Capaci 12 <br /> Cesspool: Distance, from nearest wall.. ty------- --- - ---- --S. ..... liquid clopth. ...... <br /> D; <br /> El Size: Diameter.......... #stance from foundation.............. material....... . <br /> Privy: ­­ ­--- ----- Depth... . ... ...... ..... ..................... ...... ....... . <br /> Distance irorn nea,est <br /> El Distance to nearest lot line.......... • --Distance from nearest building- <br /> Seepage Pit: Distance to nearest well...._ <br /> ell z6­6-------- -------- <br /> Number of pjfs­­j.. ..... .Q.. .-Distance from foun�dat;on...410!­..Dvistapip to nearest W line. <br /> --Q <br /> Disposal ­ ­­L;n"ng material.b-101'"At.-Size: Diameter,..-. X** <br /> al &eJ4: Distance korn n ------------De <br /> nearest Disfanc from foundation <br /> D Number of lines­­- to nearest lot lino.. <br /> .. <br /> -In of each line--... <br /> Type Of filter mater Leng. —­­.-....Width of trench.,.. <br /> 'a'.......- Depth of filter mater*, .. ..................... <br /> .41..................... <br /> Remodeling and/orpring ( scribe)-.­V-ter .- <br /> ...................— V! . !k &-;Wf-­ . ................. <br /> ........... ..... <br /> ............................... ............. <br /> Ath ­ VV.. ..... ...... <br /> + ....._.... <br /> ........ ......................... ......... . ..... .. ... ... ... ............... <br /> I hereby certify that ! have prepared this application and that the-work.41 ....... <br /> be done in accordance with <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, San Joaquin County <br /> .. .. .... .. .... ...... (Owner and/or Con <br /> fracfor <br /> By:.................................. ... .. <br /> (Plot plans. showing eug of jai. focat;on of sy5f .. ...... .... .... ........ .... .. ...... <br /> am in relation#a wells, buildings, efc., musf(Ti*Iej <br /> be filed with this applics4on). <br /> R DEPARTMENT USE ONLY <br /> ..... ...... ......................... ... DATE_........ <br /> - — 7 <br /> APPLICATION ACCEPTED BY-- <br /> REVIEWED BY ——...... . ................ <br /> BUILDING PERMIT ISSUED. ... '. DATE......... <br /> Alterations and/or • <br /> recommendation"s.1—­ . DATE._............................................... <br /> ... ....... <br /> • <br /> ... <br /> w•.w..... ....... .. .. <br /> .. ............. ........... <br /> ...................... <br /> ................ .... <br /> ................. <br /> )ERMIT No­�­ P--- fSSUED.­-/!-f/ <br />