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� lei �� \ U4r �� ' Permit' \ ~' -- -- ` ' ~~ ~~~`^'^^'"~°'` ) (Complete f in Duplicate)^ |oue u+a 6| D - /~ T� e Son Joaquin Loco Health Dist hct �no permit to construct and install the*o, herein described. /omapplication is made in compliance w�hCounty Ordinance No. 549. JOB ADDRESS AND |Oh� 1--53-43 ]fa_ 1n9tDU______________.____________._________ Cwner, Name � �u`_1-�u u�me�1------------------------------------ _ ._--_---.----_.-----' Phone------HQ._5--3142- | Address-__--- e.-________�_____. Contractor's Name''-J3�lta° ' �^ . ' , - _---.-_--._------.-----_--.-------- roona.._.c�1?59.�.'-' ! Installation will se'rv'e: Residence a] '/\portnen+ - E] Commercial E] Trailer Cour E] Motel [] Other El~ ^ | Number of� living units: . Number vf6ed.`ro' om, -2--' Number of baths .1--- Lot�size* ' �O-��NO----------------------------------- Water ''------ - ' ' Water Supply: Public system'Do' Community s�stem Private [] Depth to Water Table .40-. ft. ' Character ofsoil fm6f 3 feet: Sand �� SundE] Gravel� [� Sandy Lomm | ' Clay Loam []' Clay E] Adobe[�� Hardpan [] Previous Application K4a6e:. Yv, [� No New Construction:n &� �� ]No'� � . . . ~ ^ � TYPE OF INSTALLATION AND-SPECIFICATIONS: � ' ^UN* sepfic.tank or c8sspool permitted if public sewer is available � 2UU feet.) ' ~ ' ex1Septic Tank- Distance from.nearest. � ` .~ �eL_--.�D�f nce from {ow"dof^��n-_--.-�-Wufor�L--� .. ~'---`-__.`__-_''-_-_,-_ � No' v[compartments,''-'''' �_..''S�a-_-'-'''_�.-- Uqui6de�h--'_�_-' '. --,- /--_-__- Di,pnoo| Field: D��ance. 6*m ne�o�d'*eU� = -.Didance from fo�ndu�on'-'--''-'U|�anco to nearest ~' line . --'-''' ex I~ "^^ � NuLrnber^nf |inus----_ ---------------Length of each line---- ----------------------- ' �f of french [ Type OT filter m��''--'--^--Depth of �Kn, ma�� |------------------------Total length --.____.____. Sea :- `Did^�ni�e_+o _ ^/|�| 6nm:�+ �oU��..J�o.+..��D�fonca�fnum-foun6o. ,-_-Di��nce +o ne��o�]c� ||n ��» Number of p�` ' J ~ Lining ^ �W ---------------------- -- Size: Diameter-_-!_; ` ----- -r-----'''--''--''',-------------------Liquid Capacity_-------------------------gals. Privy: .. Distance from nearest w*U~�-��'�-� -------------------------------Distance from neunastbuilding'c ' �~ _-_-_ _ n-,_ ... ..� �- - - -_-'_- � Remodeling and/or repairinq�.4( tank syster. ---------------------------------------'-''-- -__- � I hereby certify that I have pre"pared ihis-applicafion and that the work will be done in accordance with San ~..a.c"° State laws, and rules and mm /� regulations o, ,n� ��n �maqu �u*�/ oanha�t�o� ' uin � � (Signo`d)------------------Mel � -------------------------------- ------------------f �.--r�--�-�''-�-�� '-�--.}Owno, and/or 8v�_. -� '---^'-'--''--'-'-'''''-'(/*le)-- -------------------------------------- (Plot '--'-- -(Plot plan, showing size of lot, locaflon of.system in relat4ion to wells, buildings, etc., can-be placed on reverse side). � ^ � FOR uErAR/xxEm/ USE ONLY � ' APPLICATION ACC � ED 8Y. ./�� DATE'-. ' REVIEWED BY------------- ----------- -------------------------------------..`-_--- --'_ ��--'--- DATE'.----�-�-_��''--�"'�--- � BUILDING PERMIT |3�UED------------------------------- DATE---__--.--__ _ --' Alterations and/or reo mmomda�o�� - '--- . -_-_------_---------_----=--.__.__----._-_''-_'-' ---'---_'-'-'_-.'--'-i-.'-- " - � -'_�_______'_________ _____.__' _��._____ � . . ---------------- ----------- . '-'-.-_.'-'--_''/-._- -'- '-'' ` � � _ -- � - � � ' -'''`--' --^'---''--.'`__''-''''-_- --'-_'�-------------' .-_-[_ _ -_-�._._�.___ ________.__.________________________.____'_-_---_ -_- - ----.---._-.. --- -------------------------------- --------------- -_.-_- ' ------------------------- 610 -' . FINAL INSPECTION BY: Date-'-''-' '_--_--____ SANJOWQU|N LOCAL HEALTH DISTRICT mo s*"m American Street suuWest Oak Street 132 Sycamore Street m* m*��h "C" Street Stockton, California Lodi, California Manteca, California Tracy. California , ES-9-2M / Revised W-2/00