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<br />F ,11,,, Material 'Below 501
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<br />APPLICATION FOR PERMIT
<br />SAN )AOUIN LOCAL HEALTH PI,Si ruct
<br />r AZELTON AVE., STOCK 1.,!%1 ( A
<br />Telephone 12091 466-618'.
<br />PERMIT EXPIRES 1 YEAR FROM DATE ISSUED
<br />(Complete in Triplicatpi
<br />Appi.comon P..ahy made to the w 0.str•ct fer a permit ttiionciri.. • i•i.t•.ir wstali the work '
<br />. the S in Joanien
<br />mad. tn ,.omoh.00r wolf. 5.41. r ..,.•,!. ,‘• r/•1 1.4!) f or sewage or f1041962 I,,• ;WO /hp 0.0,43
<br />Oral Health ().qtridf
<br />Job Address 4648_ E.st 1,to:/(.1
<br />Owners Name Mil T I._Okie t.
<br />`4( tr*q .11 Ifn s
<br />A‘.1,1 ,0%.; P.0- .13o2-2 1
<br />I Of Si:' _
<br />It-.
<br />I This apet;cat.nn
<br />INTENDED USE IYPF OF yin I
<br />r1 Industriai , Open Roman
<br />/37,- 7/-q-
<br />II Domestic/Private
<br />Public
<br />I I Irriipation
<br />Repair Work Done
<br />Well 'Nitrite. bon
<br />1E1 Gravel P... h
<br />Othor
<br />Appro., Tleptl,
<br />Type of Piwir
<br />I Well DI,Iniote ,
<br />Depth _
<br />TYPE OF SEPTIC WORK NEW INS! AI I A T
<br />430 .Eucira._Ild. _Pit t_Sbut..:L ,‘ ,t,t ti).
<br />WELL REPLACT11.1TNT nr rni it: T ION
<br />SYSTEM REPAIR OTHER
<br />SEWER LINES .• 503 . PiSrOSAI FLD
<br />AGnictit.ItylEt ' a4A. OTHER VYELL vet t._
<br />A
<br />nftoelEM AREA CONSTRIICTIOPi SNC.IFICATONS
<br />Tracy
<br />Dia. of ' tvAton _ 0,a of Welt Co 2" R.Ianteca Cuing
<br />Type 0 .ising PVC
<br />-..-_._
<br />SO110117311004 020
<br />newt, of Grow Seal 2 5 _ _ Type of Gri,,,q.ome.t1t_113er1E
<br />t mturn Stelat..0 Seal Install.iit hr turn_ FtlEP lora t ,
<br />Slate Work Done
<br />AIWA TION I DES1Rtic TON IN septic system perelitt,d .0 public: sewer is
<br />available within 200 feet I
<br />
<br />C "I"C teg --4141-EHM T, i..0
<br />
<br />TYPE OF Mit ;POMP 'If . .
<br />PUMP INS T ALLA TI/r1
<br />DISTANCE TO NEAREST. SEPTIC TANK NIA
<br />- FOUND A lion/
<br />rnor 0%1 1 0_
<br />PITS •*;LIT.1111,4 1.‘
<br />c.c.3
<br />Other Installation will sonde: Residence Conirnero.ii
<br />Number of living units. , Nte-lber nt bedrooms
<br />Character of soil to a depth of 3 /00
<br />SEPTIC TANK I I Typo MN)
<br />PKG TREATMENT PIT I I
<br />nettAnre In noAto..1
<br />Capacity.
<br />Water table depth
<br />. No. Compartment
<br />Method of Disposal
<br />Property Line weil Foundation „.._
<br />No P. I n t Total
<br />I I Distance Ti) nearest Well LH. Fojsdation_.._.....,Property Line
<br />SEEPAGE PITS II Oepth
<br />SUMPS I I 0-stance to nearest
<br />• _ t _ Size
<br />Well
<br /> jàudati,n.
<br />I DISPOSAL PONDS
<br />I hereby certify that I have preparisl this aptilwatum and that the
<br />le
<br />work:Avitlag one In accuroance with San Joaquin county ord•ri.ii•res, g
<br />rules and regulations of the San _manual Loral 14..Alth rtiltort 10,, ."-: t' , ! .1
<br />Home owner or licensed agent's sionature i iitithes the tedlowonp: "I ceiti rm. In the performance 01 the work for which this perma is.
<br />employ any person in such manner ,IS To bocnoto itileeCt In vvollsotani ‘COt$1V.n.atlOn laws Of Ca1if0111rIa.' C0114444C40e11 hiring Of S.ih , ontriC
<br />certifies the following:1 certify that in the performance of the work forleihth this permit is mailed. I ahall,itrtlokleg gersons subject to ‘i,orkteit,
<br />bon laws of California." '31
<br />The applicant must call lot all monitor' tn.:portion% Comm
<br />Signed X
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<br /> Title: t ;r !,/.-4 . '- Ni
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<br /> /A* drawing on ravage Ode. • t. ' '
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<br />1 ,..‹. FOR DEPARTMENT USE ONLY
<br />,/, • 1, ; • ' I
<br />Application Accepted by , i. - •-..., --- r.- ..—iii------.
<br />. . Are. i
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<br />. 4 "1D ...e __77 '-' Finel. •Inapec‘ 1,:nabrys ..“ Al
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<br />6 w_Lek - out. y l ./ ;''D.
<br />Pit ot(Grout Inspection by I /
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<br />tc.! :
<br />Additional Comments • _.. r ,, # i • - • 4: ,
<br />0 Ste 466-6711 ( I tort' 101 :111: 1 Manteca R23.7104 0 Tr,oe,S toc ecas
<br />Applicant • Return all copies In Eriv,r0/,/,,,,res $'.,, ,,/,‘ PermittServicee 1601 E. Ninth* As . r 0, as 20011a, Stk., CA 9520I
<br />; LEACHING LINE
<br />FILTER BED
<br />%Amber'
<br />Property Line
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<br />
<br /> 11,4 141IFY
<br />.4 14 15
<br />ARMIN! .F INIO
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