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OFFICE USE
<br /> FOR o CATIOAi -1:OR RANI .
<br /> APPLI N PERMiT
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<br /> Perm1+
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<br /> n Du Lica s
<br /> rrrpie+e i 1
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<br /> ... .: P. to �, ,• Date
<br /> I sued
<br /> This Perralt'Ex ires 1 Year From Date Issued m
<br /> m;t to construct and " stall the work'here 4
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<br /> ascribed` �k s
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<br /> cr•tio� is 1+flreby'made to the;San Joaquin local Health Drstrict.fo aper
<br /> �! '-pplication is'made in Cornplialice w,,fh County Ordinance No .54°
<br /> I t;B ADDRESSn^lb LOCA710N. �w ate`3
<br /> Phone
<br /> ()wner's Name `
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<br /> Phone
<br /> 3
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<br /> Fa
<br /> ctor's Nbme. �r7+r7
<br /> V6"
<br /> ,, �.•, ❑ Trader' Court ❑ Motel
<br /> [� OtEter -v� �•
<br /> E Commerclal
<br /> sial' tian,w111 serve 4es,dence ❑ Apartment MoJse ❑ h ^
<br /> .� !!= T�lumber of baths Rani t
<br /> Number of bedroarrls ,r; k �,
<br /> Number of living'umfis r tr. 1 ft r {s
<br /> I r Prrvate ,Da th to,Water Table•
<br /> -'crier Suppt/ Public system ❑ Co, munity system © �.. Adobe; IardGan
<br /> t; a.acter;of sotl to a dap+h of 3 feet aSand{] 'Gravel © Sandy Loam❑ CIay,Loam©%:
<br /> clay�F�A�A tYes[j No h� rY
<br /> } Noew Construction :Yes ❑ E No lel z � �, ,
<br /> r,.,. ,;.t•s Applica+ion pAade: pf yesdote 04N1S
<br /> a - r.
<br /> .. T ''=. car INSTALLATION AND.SPECIFICATIONS::
<br /> 4o septic tank or cesspool permitted if public sewerris available within 200 fed
<br /> pis{ante from ;ciuridat:on
<br /> Distance..from nearest waif CapautyJ.
<br /> Tank-, Llgaid depth '..! ..:.:_:
<br /> la No of compartments Size,
<br /> Dlstance:to nearest
<br /> Distance frorn neamst ,Nell from foundation ,
<br /> D SpOSd! }'IESId �r Width of tronch . ` 2 �"
<br /> `Number of lines Length of each line... f
<br /> ( De th of f iter material I� Total length ysr� r �.
<br /> TYPa of fuer ma+erlal.s .. . p
<br /> Dlstrnce to neatest lo11
<br /> t Isne
<br /> ;_Distance from fourdation .. r
<br /> I c ye P,t Disiarce to dearest well
<br /> DeptFi
<br /> I 4 . ...Size Diameter },
<br /> Number.of pits L n ng matenal
<br /> i e un a
<br /> s aistanc from to d tion n9d'n'
<br /> r., Dis+once #iom'nearesf wail
<br /> C';ss�ool: Depth.........:...
<br /> 1s '
<br /> Gn atonal
<br /> �+ Aja :
<br /> ❑ Size: D ar:leter. ....
<br /> .:-
<br /> ::- Distnnca-from nae'restlbuildingc
<br /> well " ' "`
<br /> i
<br /> Q Distance from nearest:
<br /> D;stance to noarost
<br /> lot !ne
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<br /> r : �. i m sn
<br /> ,� 1 er- Ire ; ,
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<br /> !rig and/ �reQairing [desc
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<br /> 'done in'accordance with Sart Joagmn Co`vnty;*
<br /> P F plication and ;hat the work wdl 'oe
<br /> I hereby cer+&'that,l have re aced this
<br /> application
<br /> x �>
<br /> orriinanees. Siete laws, and �,xlas and.reaulations of +he San Joaquin Local Health-District
<br /> t : ` ner a Centrecror)"b h
<br /> '�..d,
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<br /> location yste:: ?n relation to walls, buildings, etc., can be placed on reverse sided t
<br /> Showing a 6f lot, i..••..•
<br /> — ---1 FOR DEP TMENT USE ONLY
<br /> ................................
<br /> DA I E ._
<br /> jx.,. ACCEPTED
<br /> ?.... .. DATE_
<br /> TION A,.
<br /> APPLICA
<br /> D
<br /> ?.E�'IEWED BY::.
<br /> -'-........
<br /> [iiJILDING.PERMIT ISSUED.----
<br /> :......
<br /> D�
<br /> a,
<br /> or recommendations.._
<br /> , ..�
<br /> �j tt
<br /> Yi`•rations andf i/ir. �f3�y✓.. J
<br /> 1 ......................- :.
<br /> 4
<br /> rser
<br /> - - __ ................ e
<br /> . i
<br /> y�l [
<br /> ................ ...............
<br /> }
<br /> Date. "•••......
<br /> FINAL`INSPECTIO
<br /> };r JOAQUIid LOCAL HEALTH Df5TRICT
<br /> 9th Slrest
<br /> 124 Sycamortr Streai ,7-;•
<br /> 'a• 300 Woof Oak St:wf frac California
<br /> 1b1Y7 E.Haultoa Ave. - n!nnleca.California Y•
<br /> Ladir California
<br /> SIPMan,Carlfora;a
<br /> �e 4
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