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<br /> APPk.ICATIOtJ fQR SANITATION cRMIT
<br /> Permit,Noy
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<br /> {Complete in Duphcatal' ;°`Detetlasuedr �. 211` r
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<br /> ,nation Is 3toreby mase to the San JoequrnxLocat Htalth District;fOr a permit to construct end Ins#ally a wbtic he se eitn'hed
<br /> dica�lor, is made in compliance wlth'.,Coun Ordlnaace Na 54g fp
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<br /> l 1 LbCATION. r 'z' its t r
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<br /> ,. .i'.:S ADDRESS AND A _ f anPhlx �a�as,, '.r, �!•
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<br /> t �' � TroiE .Coiirt'Y❑ t�btel � �C ,y
<br /> • r drtment Houss � O 9 fel Yy a 99 ,q,t �`+ �° Y.�r
<br /> int ration wi11-serve Iles,o6n e ,,Np , ' Lof srie `
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<br /> Number.,of Ilving unsts ^. Nur,beri�f bedrooms Nun er of baths 5 H = � �� �✓.
<br /> x i ` �''pnvato z'l jxapfih to V/atet;Td 1 ` ' ww
<br /> 0;' Coh,rnunlfiy sy€#em
<br /> i" "r'nbRr Supply public system f, f la`y'� Adobe >.H a it
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<br /> dy Loam 0 CleyOam ✓J .; ,�1� >.-ys:
<br /> Char actor of soil��to a_depth of 3:¢eet Sand� _ 0�a_ ,1 2 , ° ✓f ) '? M, 112,11- .� - -l�ew Ganstruct,onVA gs�]dYes L� No ( a <k f �r first r
<br /> T`r PE OF lNSTALLATiO*L-=AND SPECIFICATION$ 4 a r .tib rf a it
<br /> (t+10 septic tank or permitted if publiasewer'ls available within 2a0 fsetj
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<br /> { �' i3istnnce from noa"'t;weN ��0' x p,stance frer�F^foundatlon ^
<br /> J +� � h �r r r{ Caeacify:Y
<br /> c Tan f F , r1 SSZe yn + r ,LIdUi rdep+ s 5 e y ip. i;Y Jft�:x F
<br /> .. No of conpartrn@nt5 r- .ty.l,,. ,� ,-,� §f '•' an a GM •sy L fin-�
<br /> Distancojo hedr�s#FlutDlir
<br /> 'sr F Id Dlsta`nce from:.nearesfi;well '� i � Dls#ance from foundation f 1` ayA�
<br /> G o_e F Len th of each:line a -;:Wldtli. frenciz�' y
<br /> Number of l,nss f g ,
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<br /> ! t^De th of finer metenal r' C r 9fr 'j?7N:r3 r; : a.•7
<br /> Type of fiber materlaf �' {-�
<br /> u Z i t y.Distanceo"nea lots Ina �s a .w
<br /> _ �liMncR-to neares we .I IS+anC9-{COm nfOUflC�d�iOn '_ �+- , y ,�
<br /> Seepage L
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<br /> 51ze Diameter'
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<br /> Lining.
<br /> matenal
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<br /> - •• DI tafice rOinjq datlOn r +_ �. Ay�ea �r.�,F3 r1�S
<br /> C Wool r D.tante from near`e}�welldh`
<br /> t t r' s LlquldCapecJtyr+ i s f ? ,ate
<br /> f, xts rFDepth� v, 9
<br /> Size. Diameter r f r +fir Y' n r i'^" i,:
<br /> tiY DlstdncB fromnearest
<br /> 's `b ,,', Distance frofs, nearnst.wel! t
<br /> DI-tante fie nearest lo# Ilea �� ,_ a
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<br /> modeil�nq-pnd/or epa{rl`g �dosc'rebi++Ka�r. T 4 �f $ i. 1 i ; __� r� 'stc
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<br /> w },.reby,eertify.ihat I have,'prepareil:'this,applica4ion.and thmt t}tewaa►k will be done in accordance wife►Sar�•.loaQuirt,aCokn
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<br /> State laws,,and rule's and'rejulations of the Sanf.Doagu,n Local Flealth Distrief
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<br /> (Pio# plan,showing sae'of lot, locat,en of systerri in relafion#o weEls, buildings etc.; can be placed cn rererssrsFd41. ,w 4
<br /> FOR DEPARTMENT USE ONLY
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<br /> CEP s ED BY
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<br /> Alterations aria/ar..recommendations
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<br /> NAL INSPECTION BY..... :,...
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<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT. J
<br /> 132 Syurton Sfrert 014 Mor}6;'Cr'Street ' M �,s
<br /> 3DD West Oak St"a+ Trac Caltfarnia
<br /> 130 Savth Am0riaen $4ro*f Dodi, California Me 7:Ice, C4lifomis Y .
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<br /> Revi>;ao 1.57 F.F CO. .
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