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I i "OR CFFICE U'SF, <br /> APPLICAMN FOR SANIi.AMON PERMR Penrit No <br /> • - . .......... . . (Complete in Duplicate) <br /> irnis Permit Exp;ros 1 Y.irl FromDaiu Issued Date Issued <br /> Aga.lcetioaflion-4 <br /> ;hereby made to ttie Sen Joagr Lo:al I[eallh rJi;frir,} {cr e pe m t to construct and in tall rhe <br /> work harroir described <br /> I This made :n corrpiia.•,ce wi4, Ccuniy Crdirance No. 549. <br /> JOB ADDRESS AUP+ ess <br /> L,OvjC�Al_+T.�.I.O�N-,.._. i-?� . f. .. �t •.+ <br /> .i.l.... / l%/� ..... one. <br /> Owner'Y Name..... ..._.. .................Addr <br /> C r r' : . r _ <br /> Si <br /> ' <br /> ' <br /> ...... ................... ......... .... `'*a � <br /> i Installation w:ll serve: Res''.^.ice Q,";lpartment House ❑ Ccrnmarcial ❑ Trailer Couri (] Motel ❑ _ Other C' 3 .r z <br /> Number of living unifis: ._I_. Number of bedroomrte. <br /> s . Numer bcf bn3hs ..,�.. Lot size .: n2rh'.P <br /> Water Sue Publics stem Commur;l system Private :?e th To Water Table . <br /> ��� y o •� y n �- p <br /> Character at soli to a depth of 3 feet: Sand❑ Graw,' Ll Sandy L.oam❑ C!;,,e Loam [B-'Clay C3Adobe�] �lardpan❑ 5 } 3,5 <br /> ' Proriouf Application Made: of yes,dpfe........... .. i ..0 New Construction: Yes ❑ No ®---FHA/VA Yes [�° , <br /> r, <br /> �••• TYrE Or INSTALLATION AND S��.tFlCAT10N5: � • a '• �' � <br /> ` st <br /> (No .ePtie fe�� .x eerspooi permitted if Quelle sewer is available ivlfhin 200 feet.) ' <br /> / 7 r kY s y <br /> Septic Tc-x Distance from rearesT Wei-MV...t;Estan a/ ons #cunoat,on..._ fU...Mat�nal..,(i �+f J�+ •� i y4'' <br /> [ No. of compartrnenls.. .f. . ..... .....Si:e.> ._....... .........Liquid depth....y ..............Capawty'. <br /> Disposal Field: Distance frcm nearest I .���. ..Dis�ance trove Tcundafi n... � Distance to nearest o�hno .T <br /> "1�� n, ,j, , t <br /> Number of lines_:__._._.-D'� length of each l.ne.,, Q.. Width-of trench�'• a . <br /> Type of.filter material,. �; Dep'h of filter r:_,rterial..� Tofiai length <br /> Seepage Pit Disranu to nee:Ps' well.�00..._._Distar.[e rr�jn ce�defion:._. .._.flr} ce to neere•f Ipt ilne�Q 4 <br /> P;ur-;oer of n;ts.__�__ .LiZ;ng materia:...�L1� 1'v..`ae: Mameter:1 <br /> �rbm reeve } ws! _Distance Tram founde}ion... ._. LFnin materFal [ <br /> g Cesspool: Distance g <br /> • ." y <br /> ❑: - E:ze: C.4ameter_:.... --. Depth ................. .... Liqud Capiirl gals <br /> rivyis}an;s from oearest,wr l!-. . . . .- -- D;s'arce from neeest buald[rg � <br /> P`` ❑ Distance to noarest lst I:re_.:;.._, .._._ _ iE #1 <br /> Remodelintrd[or reee�ri�ng {d scribe �/.'�/l✓.._... 4(!�X-GF <br /> ......---------------- <br /> ....:............. .. ... . ...- -....... <br /> ....... ........- ........ ... ........... .................. <br /> 1 hereby certify that l have prepareF;'ili: .sppl-cet:on end lila? the work will be -Ione in accora ice WA San 'oaqurn C.ountj `q <br /> ordi:sances. StOo laws• and rues and rog�!stisn: of the Sen Joaquin Local Heslth District. <br /> ._,.... ...... .1e'.ti+»e pr-EoeriratFor}�` s'a` a <br /> (Title t. <br /> w <br /> Pi,-t ranem <br /> , shoving sire of lot, location of syst , in' Iotiori to wells, bui?ding:.. efG, ran be ora�.ted:on r4verse sFde� <br /> _ —�— --- - FOR DEPARTMENT-USE ONLY <br /> APPLICATION A,,,ZEPTED EY.. tel. � �-rC �``�". DAT �.�:......�...... L��s2 <br /> REVIEWED By............... ..... DATE <br /> BUILDING l'i Rf1lT ISSUED................ . ......... . . .. - DA7! <br /> I Alterations and/or rerommes,eitions: /! j/// T <br /> r"--. /� —/.(. �r..� .:...,.. .. .�._tif-l' c-1•v7—y. 1:.i - .-Y-L"1 j1•�'L.. ... _�� Zw..:Lb,ea.... .`.t_.. . �_a� ..✓..:. { .._ .. ... - <br /> �. <br /> - ....... ........ .. <br /> ��-+, .. .. ... .. .......... ... .... . .. ......... .............. <br /> .. <br /> A FINAL I SPIE' iCN Ev. 1 ` � . date. �'C %. .t:?. Lr ..�.. <br /> I '" SAN ?OAPUIN '_OCAL HEA i TH DISTRICT _ <br /> 1Su��:�!+wr•�ran S!.r" 300 Wa[r Oa'•c.•.., is sr[amar•Sl+..r 105 Woe 9th_,"Frear <br /> 9IS�0[tre�,Crfre.n.a Lc di,:oSi:•rn: - -_^14re.CUM.";. Traq,California - <br /> 1 t <br /> t <br /> �1 <br />