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�4"�_4*� ^~.~ � ' ' 'APPLICATION FOR SA/nnA/mO/v rEmMw/ Permit" No. ---^~^-~'- ^ ^ �� Ou��*f� r-''r-- Date IssuedApplication is [ hereby mo6o to the San Joaquin Local Health District for o permit to construct and install the work herein described. This application is 6 | with County Ordinance JOB ADDRESS AND LOCATION--,-: ------oa------I------- - -- ------ -------- Installation will serve: Residence Apartment House El Commercial E] .Trailer Court V-Do"ofel E] Other El Number of living units: __�" Number of bedrooms J—Number of baths %rLot size 1-i--- 4------------------------------- � Supply:' ' --- ' system] -- -- � - ~-.°�� ��a�� m@ � m 6�h � 3 feet:� SandE] Gravel [-] Sandy Loam El Clay Loam Clay E] Adobe �� Hordpan0 Previous Application ��e; Y� �1 No ��No* Construction: Xs � No �� FHA�A. Yes � No �— | �� ' ~~ TYPE OFINSTALLATION AND SPECIFICATIONS: /No septic tank wv'nesspoo| permitted if public sewer isavailable within 200 feet.) / . �is+un»o from n�*,o,� veU-----..Di�nnce from foundation------------------- No. ofcumpor�hxn+�-��_��_��-.�5�o-__.------._�qu;6 d�cth----.-_.--.C�po'ity_.------ 4e�ptj ' v ' 190 / Distance to nearest lot line---47 Disiance from n,stn __i--��' Distance from foundation � Number of |� of each ^ Width of *n Type of filter moffehoL � ' Depthof filter mu+e�oL-�� ---------' o+ | |e�no~+h--�� W - ._ _' �.. . ------Distance .~~.~.. ~Se ' Distance +o nnorn`. well ----' ~......~ 4� Num6arofp�, -'/'--�.�n�g materia --- '3�v� D�mo+�r' " Depth -------------- .1 ' �^« ' Cesspool: Distance from nearest well '-'-''-Distance fnzm foundation--- �Lining mo+a6ui'-''-'-'--''-'-- ~ 171 Size: Diameter..------_------.Dept k----------------------------------------------------Liquid Capacity----------------------------gals. | ' Privy- Distance from nearest voK'--'-'''-''''-'''-''Distance from nearest building------------------------------------------~ F-1 Distance to nuure`» lot |inx _ ---------------------------------------------------------__-.-._.--.---.-- - � Kvmo6ning and/or . pairing �ex �b��'''-�-'''-' '-''--_--_�'-'--'-----' / --'-----'----�-`'—''--'r-----'----'---'-_-- ______.___._______. ��_��'��_�__��__��__��_��__��'��__�__�___��_��__�__��___ --._._-_-----._--_--__.!----..__-___-_'_._---_-_-- .___.-._-_--'-__.--._------.-- | mt | have ' that the work"Will be done inaccordance with San Joaquin County ordinances, State laws, andAules and regulations of the San Joaquin Local Health District. Y~ (�|gnoJL-------�6�w-��'.---��^P��°��- ---------------------.V2ww�w"m**�*r Contractor) By:-'_----_--------------�x�'��M�`..��'..��-.-----------..O7t|e8 -------�� /P|wf p|mn, showing size of lot, location of system in relation to wm|ls, bu||6|ngo, o+m.. can be placed on "w,ome side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DY-.^7-'��-"--------------.---------.. DATE-..�3-97�5�7_________. � ' REY|EWED BY---------------------------------------------- DATE.---------.-.-_-_-._____.. | 8U|LD|NG PERMIT ISSUED-------------------------------------------------------------- DATE-------------_.---.-_--.--_._._ � Alte,uHonyan6/nrrnowmmendationu---__------_---_..__._----_�____._.__-_-_-__-.-__---_- / ---_.'''__'-_.'-''-_''_---__''--'_-._--�--' � _--__---^-^^---.-�,-.._~.~.~-_.--�-'--_-.-----__-----__.____---_.___-_--_-_..____-_ � ' ------------------------------- - -------------------''--.'''-''''-'---'''-----''-'-''-'-'-'__.-_ ' ------------------------------- -'---------'----'-----------'-----' - ��- | 7- FINAL INSPECT - D°+e''��./''-��'-'=�^� -��''--'-'----' ' . SAN JOAQU|N LOCAL HEALTH 'NSTN��T South' /no s". American s�w� 30D West o^ Street ' ' 'ax Sycamore s�e° e14 North 'C' s*"° Stockton, California Lodi, California Manteca, California na"» California / . ss-i-zw n"./,°a 1.57 p.Pzo.