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SE <br /> APPLICATION FOR SAWTATION PERMIT Permit N.. ..L42S t <br /> ............................. <br /> k <br /> ­­--li--------------------- rAmph" in D"409* Date Inued <br /> ................................... I This Permit Expires 1 Year From Daft Igggi <br /> .kation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin dwnlmJ. <br /> 4 application is made in compliance with County Ordinance No, S49. <br /> JOB ADDRESS AND LOCATION.......TZ .....--•... I.......................................... <br /> ---- ------- <br /> Owner's Name...........)-I,- ... ._de�. .......................................----------.............................. <br /> ................... -------;;;A-......................... ........................ <br /> ­*........... ---------------------------- <br /> Contractor's Name..... ..... 1-411AL........................................ <br /> Installation will Sam: Residonc* 10 Apartment House 0 Comrhercial [] Trailer Court [] Motel ❑ Other [3 <br /> Number of living units: ..!.... Number of bedrooms _I_ Number of baths _,J--- Lot size .......)(.-4,0................... <br /> Water Sip*_. Public system g?"Community system C1 Privets 0 -Deptk to Water Table _If ft. <br /> Chersdar of volli'Vere depth of 3 feet- Sand E] Gravel El Sandy Loom Cj Clay Loom [3 Clay(j Adobe V Ho"llpan C3 <br /> Pr*viow Application Made: (if yes,date-------- ----------I No 12 Now Construction: Yes V No [D FHA/VA. Yes 0 Nom' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic took or oosqwoof pern*ted if public server is evelable wKin 200 40.) <br /> Septic Tan - Distance from nearest wail-----------------Distance from foundation....................Material............... .............................. <br /> No. of compartments..........................Size..........___-----------_-Liquid dap�th___.................. <br /> Disposal Fie d: Distance from nearest well.................Distance from foundation....................Distance to nearest lot <br /> Number of lines.......................... ------.-Length of each line.............................Width of trench.............I...........I........ <br /> Type of filter material...__................-Depth of filter material-----------------------Total lenO...................................------ <br /> a <br /> S"go Pit: Distance to nearest -------Distance from foundation...LjO............Distance to nearest lot iine.-I ........ <br /> Number of pits......!..._...--. _-Lining material....114,c.Al. __Size: Diameter-.43............Dopth--Zd <br /> CAMP001: Distance from nearest well-----------------Distance from foundation....................Lining material.._..._....-------------_--.--.--- <br /> Size: Diame+er-.....................A..............Dep%... ------..............................Liquid Copecity............................"k. <br /> 0 <br /> P'ic Tan <br /> E� <br /> Disposal I,, <br /> l ng,............ . <br /> Privy: Distance from nearest wofl.................................._...... .......Distance from n"r##,.buii ......_..------------•• <br /> ❑ Distance to nearest lot line........... --------------------—------- ............ ......... ...... <br /> Remodeling and/or repairing (describe):--------44-A... ... ...... ------ .............. <br /> .. .........__­_­­—-------------------------------------------• <br /> .­............ -------------­--------..................... ............. .......................... ...................... <br /> ..........................I.......... .... ­ <br /> ............................................................ ..... .................................-------•............ .............­­.............. <br /> --------------------------------------------------------------- ................................................ <br /> .........................................................--------------------------- <br /> d. <br /> I hw*4 cartify that I have prop" this appketlon and that the ww� wig be done in aacw4wwoo.willh San Joaquin Cwmily <br /> onikenco% Ste% 6wit. and rules and regulafions of the Son Joaquin Local Hogth Wkfirk:t. <br /> .............t�.�......... <br /> ....S ------------_-------_--- aw/or C44*691001 <br /> By:...... . ......................................I.............. •-.._.._._...... .... --------- ........ ...... <br /> (141of p6n, dtowing time lot, kmAw coF rptom in ralldlim to wok buldbbgm, etc., can be p6 on <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----._. DATE---- <br /> ............ <br /> REVIEWEDBY...................................... ............................................................................ DATE-••--•••=---••....•-•............... ........... <br /> BUILDINGPERMIT ISSUED............ ................................................__----------------- ---------__. DATE..........._..._._.. <br /> Akerefienmod/or recomwAmdafkwa:............ ............. ...................................................................................................................... <br /> ......................---•-............t.............................................................I.................................................................................................. <br /> .......................................................................... ........................_..............................................................................­............ <br /> .................... <br /> ...................I....................••--••--...---------........_..._. ..._... ............................I............................................................................ ...................... <br /> FINALINSPECTION BY:...... ........................... .......--------------------- Date--_-_-------------------..........I........ ...... r-•-•-.......... <br /> SAN JOAQUIN LOCAL HEALTH 1XST1tICT <br /> ISO Sook Anwtain S"W So wow Oak tweet 124 11cbmwe 91 201S Vft*9&ur"t <br /> S*dftvt.Ce Womis L"4 CANWWRiC memen,C4"#W*W Tmr,Coulm <br /> RA 9 OrVISW 6-69 R0 9-481 ATLAII <br />