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=� <br />` <br />~� <br />- ' <br />'x ^ APPLICATION FOR SANITATION PERMIT Permit No <br />' mmo�+o |n <br />k�Dm��afm <br />» ^ » <br />(Complete Duplicate) - Date Issued_�/ 0 <br />4// ' <br />made to the SunJcmquin Local Health Bi�Hct for u permit to construct and install the work herein described. T��opo|�ot�n is made in compliance �kh County Ordinance No. 549. ` <br />JOB ADDRESS AND <br />-------- <br />Contractor's Name-----------------------------------------------_-----.------------------------------ P6on .7�fO�w�7 ----- - <br />. <br />Installation will serve: Residence House E] Commercial E] Trailer Court [] Motel 0 Other L] <br />Number of living units: /- Number of-6o6mums ..;�~~Number of baths .^�-' Lot size -------- <��.�^�����...-------' | <br />Watev Supply: Public system Eg-�Ommvnify system E] Private F] Depth to V/ute, Tu6|o !�/ t ' <br />Character of soil to m depth of 3 feet: 3un6 [] 'Gravel E] Sandy Loam [] Clay Loam ] Clay E] Adobe 2--Hnr6ponF1 ' <br />Previous Application Made; Yes 0 No &--New Construction: Yes Ej No �H ' A.Yo, [] Nn[] <br />TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br />/No septic tank or'cmmpmo| permiftw6 R public s er isavailable within 200 feet.) * _' _ - <br />/�� <br />Septic Tank: Distance from nearestwe|| Distonco from foun6ofion' �.J�--.-��afe i | ^- .. ---.. <br />No. ofcompartments -.-�L---...Ii�o-���.^��..'�--..Liquid �op!h...-.. ..Cupa- <br />| F� |6: Distance from nearest weU----_-Distanco from foundation -------------------- Distance to nearest lot line _---.-- <br />Numbnr of lines -------------------------- ------- Length of each line ------------------------------ Width oftrench ---._------. <br />Tvoe <br />� ^ofGKer materioL---. Depthof filter mofn��--'--'--^-Total length --------------------- -�—�- <br />�-- <br />nearest �t|i. S Distance +� <br />...... <br />op�.��Diume+er-..,��'D��----Num6or of pits ------ /----.Lining material'- .S|z: <br />��� <br />. <br />Cesspool: Distance from nearest °v�.—_-._Distance�nm foundation ----,--'�ning mafo�aL-----.---.__ `~ ' <br />Size: Diameter --------------------------- ---------- Depth ------------------------- ------------------ .--------- Liquid Capacity ---------------------------- -� <br />Privy: Distance from nearest well D�S+nnce {n,m nnore5fbuilding '-_- <br />_-_-- to nearest- _ lin-_- - __ - . <br />/ . <br />' <br />Remodeling and/or repairing k]eozi���--''-'''����_-��,_'__.---_.''�--'----'-__-_-'--__.'-_-'-_-- <br />�.........._--___--__---_.._____-^---_-.__._'-_-_-_--_--_-_-------------------------------------------------------- <br />------------------- --------------------- ---------------------------------------------- ------- ._------------------------------------------------------------------------------------------------------------------------- <br />-------------------------------------- __'__________________________�______�____'____________________________ <br />/ have prepared this application and that the workw8 be done ,6 with San Joaquin County <br />/pu a� � <br />� ` <br />\S�noul_f.w^`�*mae~�.zc <br />�By:- ------ -------------------- 04-t-11 --------------------------------------- (Title) ------ a/, ----------------------------------------------- <br />.plan, showing size of lot._. <br />of system in rel flic n to wells, buildings, etc., can.6e placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />^ . <br />REVIEWED8Y ------------------------ -------------------- -------------------------------------------------------------------------------- DATE_'''-_--_.--..-__.-___._. <br />BUILDINGPERMIT ISSUED-----. -------------------------------------------------------- DATE -------------------------------------------------------------- <br />40 0.0 <br />SANJO/QU|NLOCAL HEALTH DISTRICT <br />130 south *m°ri""" str°°+ 300 West Oak Street 132 Sycamore sxre~* 814 w"*h ^cr' Street <br />