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f OR O'FF'.CE USE 7 <br /> • APPLICATION FOR SANITATION PERMIT Pwm't No. ... <br /> (Complete in Dwpliea„) Date Issued <br /> Ths Permit Eapires 1 Year From Oats Issued <br /> .",Application is hereby meow to •Iv Sen Joequ;n Local Health District far a permit to tanstruc' a"d ,n MII the wwl heron deserted, <br /> Th s app6 cati g m «jVpj.a"ce w.'h Coun•V Ord�neMe No. 549. <br /> S`S - ID <br /> JOB ADDRESS.AND t•' IOhIGAW.. S/A. I✓. .vF 1� <br /> Owner's Na <br /> I'/a �I�'l�fr`7e'>Gt/ `+ Pflone. ... .. . _. <br /> Address... � .. _..._.. . _ ... ..-. .._.. .. <br /> tmtapation will terve: Ret,der<a 2? -•oartrmo t House ❑ Comr•sar<ial ❑ Treiber Court ❑ IAOW:�❑p�Other ❑ <br /> 'dumber of Irving unset. I Nimbo, of bedroofari— . Number of books A Lot life%,[K/ef�>r - - -- - <br /> ' / <br /> Water Supply: eublrc syslen+ ElCamrnumty system 0 private 11(6epth to Water Table ` ' tt. <br /> Cha.aoor of sol to a depth of 3 fe01 Sand ❑ Grnve' ❑ Sandy loam QTley Loam ❑ Cloy ❑ Adobe❑ Hardoer ❑ <br /> heviovs Appik0lon Made: III yes.dote I No 15'.-New Comtrw,c^ Yes Z;.^o [] FHA/VA. Yes gD,.fJo[] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tall w u:.ompool pormi4fed if public sewer is available wiWm 200 feet-1/ <br /> 00-. ._ <br /> 5op•Ic Tp"k� 7nre ice irm„rn r+esralt wt �BD Dista a fom�foyu.�.�/defoR, <br /> : /0 .. . tletoilsl &4,9f� <br /> - <br /> I40; No. of coparmants -... Si 'C.,id depth .059" CapecAvow <br /> Alf ala/ D' <br /> 0•scoul Fro'd: Distance from "e� we:•.�py- Ditta�ce from fwndet o" � �ilarq b nearest let line,�. <br /> Numow of .,nes _.. Length of each tire .4Gv' aro- Woo of tr q� <br /> Type of fare? mmatw- l./tl Daptm of f"lte, matorial�� rotal <br /> Seapego P,t•. Distance to nearest wet .... Distance from foundation ....... ... Dlstanta <br /> [] Nujmkw of p;f$ .._.. Lin'nq material ...Sire- D;ernater Depth <br /> Cesspool: Dista+ce Lam Poorest ,,all .. Distance f•om foundn•;or, .-. . . L;mnq rnoter-el <br /> ❑ Size: D;amooer - - - .. Depth - ....... L;qu;cl Capacity , .. ..gels. <br /> P%ny: D'vtance from "carett wall. - Distance from noaMst budd,ng ._. <br /> ❑ Distance to ocerest lo' line . .. .. ... . ........ .. .. <br /> Rwr.odating and/or mpworc; (datcriioe): <br /> I heroby certify that I have prepared this appliction and that the wol will be done in acewilance with Sen Joaqu%n County <br /> ordinances. State lew/s, d rules and rogulatiom of the San Jwquin Loci Health District. <br /> IS;geed) <br /> (Flet plan. she+isq aloe of feR Iseellae of ryctom r ion to walls, buildings, efc.. un de Placed on reverse sld*F i <br /> _— — --- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. _. ....._.._- DATE <br /> REVIEWED BY . . _. DATE <br /> B'UILD+NG PERhtl* ISSUED ..._._ ...... _. . _ DATE <br /> Alterations and/or r#4*wAw*nd&f;om ; __ ... _... .. ... ... . <br /> FINAL INSPECTION BY. Ct°'� �_ `•� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> IMI l I v"e A. Ieo w...aea 1•.ee, 1 to tt.a.r.e t.r.N 205 Wev err.w•M <br /> treueeew.iaMwwla leap.<N.,e•.w w�r..e,c.-.'. fra<r. <el�h,w.a <br />