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- APPLICATION FOR' SANITATION PERMIT Permit No. <br /> |n ONokcmfa . . <br /> (Complete ,--~' ' Dm+n |,o�e6 <br /> LocalApplica-l'icin is hereby made to the San Joaquin <br /> Health District for a permit to construct and install the work herein described. ^ <br /> This application is made in Zdffipli-ance...with County Ordinance No. 549. 0D- 0 <br /> West of 9-1. <br /> ----------------------- <br /> J <br /> Address-_____-_..Ame-------------------------------------------------------------_ -----------------------------------------------------------------------_____________ � <br /> Con racfor's Name-------..]�AFXZBH...M-C-n---------------------------------------------------------------------------------------------- PhoneRAROAQ7------------ <br /> Installation will <br /> -|nstallationvill serve: Residence KI Apartment House E] Commercial E] Trailer Court [] Motel Cj Other [] <br /> Nor�;6urofliving units: 1------ Number ofbedrooms 2----- Number ofbaths .]L.- Lot sba5O«.__X..lZ5«------------------------------ <br /> �� <br /> W� Supply. Public system � ' {�m�� system E] P��� Depth to Water Table �- ft. <br /> Character of soil to a6opth of feet: Sand [] Gravel E] Sandy Loom [] Clay Loam E] Cluy [] A6o6eX)l Hor6pmn_KK ` <br /> U � Made: . No%�� New Construction: Yes�� No E] <br /> . <br /> TYPE OF INSTALLATION AND SPEC|F|CAJ|ONS,~==� <br /> . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />. <br /> Septic Tank: Distance from �au,o,t ~v|L50t- ---Distance fro6uun6otion-30.'.�._-._ iuiC-C' ]� <br /> , ��ic� ` .+" <br /> KI No. of compo'+mont,..��------- "~ <br /> �ia,.���� 36 pjC6.3wLiq6 <br /> ui6 ep�h--- ��------Cupocit�x0_V----- <br /> Disposal Field: Distance from' ] <br /> � ----- ------ <br /> u�ne�t ~� � .���toncv from foundation-------------------- ----------------- <br /> �nxe tonoon,�� |ot |[me <br /> 0��� Number of |ioes° -----------------------------------Length of each line-----_._.—YVi6+h vf �anch---_------ U� <br /> --- Type of filter material------------- -----------Depth of filter material—L------'7ot | length------------------------------------------ n` <br /> o *� �V <br /> Seepage Pit: Distance to nearest |gD»'._- n�urud | | <br /> ---------- <br /> Number of pits------,1-------------Lining muferia| Pr�PX____ Size: Diameter-3311--- --------Depth --J-9.1--_�� <br /> Cesspool: Distance from nearest well-----------------Distance from fovndution------- Lining material <br /> E] Sizeo�mo| Depth <br /> ~-°~~ --`--'--~ � -------- �� �� - <br /> - '�' Distance from naa,e� w�L''--''--�''--''-'-.Distance <br /> from nearest 6ui|6�g------.-__-'-'- <br /> �]' Distance � �� |� |� ' <br /> nearest o---_-'''-''''-'''—'-_.---'--____'-'_______________________ <br /> and/orRemodeling <br /> d _Pal -4gre.&kle " <br />� ___TAi; -»hn-'rai^^y---seas-on°^------The----~bo"`"----ape^^^^''have...~~~~~w---~~~~^~~~-------- T ' <br />� --------to---b_e--.8�f ---'- ------------------------ ' -----------------------'-------'--'---------------'' -� <br /> —'''''-'---'��_''-''''�----'-_---__'--_.'-_.-'---''__.''---''''-_-'''----'--__'_-'-'''_-'���-'' <br /> ` bib done in accordance with San Joaquin County <br />. ordinances,. ~.... ..-~ _- rules_ _- regulations of ' <br />� \ . <br /> (Plot plan. showing of <br /> system in re4ion to wells, buil�ding tc.. can be placed .on reverse side). <br /> APPLICATION ACCEPTED BY---- ----------- ---------------------------------------- D»/� <br />| <br /> _________.. v= -REV|E$ B) BY---------------------------- -__..-''----'-'''--'----' DATE-------- <br /> _ <br />� _' PERMIT ISSUED----- <br /> ^ <br /> ---------- <br /> ----------- ---''''- <br /> -----------_---_---_.____.___.__.- <br /> A�ora�wnsmn6/or ,ennmm*n6aHmno;--- - - ------__----.-.-_----- <br /> ----'_----------------.----------_---_--_--'-_-- _---- — —..__-._--___-_- <br /> ____________________________________�____`____________________________________________'_ __- <br /> -''-_-'-''- -------^'''--''--''--- ---'--'''-''�'-'''''-'-'-''''--'----''-'- -------------------------- <br /> ---------- <br /> '-''-'----��-------- ------------------ ---- ' <br /> � r <br /> FINAL |NIPE{�T|ON BY� �—�����--_-.��'����____- Du��----��-�-------.---.__-_-_.- <br /> . . ' <br /> ` <br /> ' SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> oo South American Street 3mmWest Oak Street oz Spwm"= Street uw North ^o^ Street <br /> " ��| California �un��m California ?�"v California <br /> mm"a�". California . . . <br /> ~S44 ^^^ "" `=° <br />