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h S fff <br /> q FOR OFFICE USE <br /> o;:. .... ... " APPLICATION FOR SANITATION PERMIT Permit No. <br /> yY G <br /> • (Complafi in Dnplicetel Date Issued b' <br /> r ;,;,.„: :. TSis Parm't E%p res 1 Year From Date Issued ' <br /> r ApplicatictZ is heroby made 1. the San Joaquin Local Haelih District Tor a permit to construct and install the work ha iinnOJFKc J �t <br /> e in compliance with County Ordinance No. 549. , <br /> if <br /> -'This application rs me /�^^ <br /> t JOB ADDRESS AND LOCATION .( RIWAIS <br /> .,� <br /> tD' <br /> - <br /> Phone <br /> Oner's Name,.... //........ - _ <br /> Addres. ...._ �0S—.. &.......M tn - h10 . . h <br /> A NIAECO ... t'tr� f�vrl�r: <br /> Contractor's Neme... Phon. ..... ..... w;” <br /> �d <br /> . Mo}el Other ❑ [_.. <br /> installation win wrra: '.Residence Apartment House ❑. <br /> Commercial ❑ Trailer Gourt ❑ n ❑ <br /> y ' : <br /> N .... Number of bedrooms... Number of baths ,/..... Lot sae <br /> umber of living units: ..� s � t _• , <br /> We,}ar.Suppfy: Publicesystem ❑ Community system -PrivatgE DBP+h To Water Table' <br /> { Clay Loom)Clay❑ Adof s❑ Herdpea174r,k n; <br /> Chareetw of soft to a depth of 3 feet S vel ❑ Son y Loan O y - <br /> ;'y . , FHA/`/A,Yes❑ No��si e' <br /> .y t "Previous Application Mad@:. i:f yes,dote....-........ 1 'No L� New Construction: Yes [l��'o ❑ <br /> ysi'�:TYPE OF INSTALLATION AND SPECIFICATIONS: ,* _ <br /> ' ;(No septic tankor cesspool.permrtMd d public seweFfis avadebb wifnm 200 fee}.) <br /> t +�r.-> Distnn n front foJnd.t on L.C.......- <br /> Motorial .� <br /> {' Sept c' nk <br /> Dist from neares well- XJRx 5 ,quid dapfh ..... Capacity 1 O 1 . <br /> •'- �'. No. of compartments, Sae .. <br /> + r ' - 1�. Distance t> neenst lot tine 5 <br /> a Dispose inid. Number from s....nearestwall ,a� Length <br /> from foine m Width of trench 'i-9�'1'� <br /> Number of-.lines, �}� . .. -.Length of each line r <br /> Typo of filter ma /sly-�^ .Depth of filter motenal.....�:1 Total length ;' Q , <br /> s� .,Jp �nce to neamst loll <br /> z�r-gip Seepage <br /> Fit:' Distnnce to neo 4it well ��.�1....Distenco from foundet on <br /> { <br /> Number of pits.. yLr-Lining matenel:_ sD.C.L� 5� a Dwmetalj rr Japtli.. ` rf <br /> '.4rpy,t r1 rA✓ Lini <br /> sx�`�C. <br /> �6�,Oi?r esspooh ^Distance from Brest well Distance from foundation Lrqu d Cape <br /> Sf20: Diemntec.. .... Depth _. ... _ <br /> ial <br /> city .. 9als <br /> g i}_�;Privy: Distance from nearest well.. .. <br /> .'Distance from nearest bwldmg - <br /> Xft •❑ 'Distance to nearest lot line... ........... ' <br /> tir 3r° <br /> ` fjpaodeling and/or repainng (descr be) '- ` <br /> .... <br /> n1 <br /> ...........and A / ... I <br /> ' vgYhet 1 heveRrepered 4hrsapphca+ion end +het}he work will be done m accerdence with Sen Joaquin County ' <br /> ` - t law and rules d gulafions of the San Joaquin Local Health Distract _ <br /> ,rfrl+ru•v� I vc� ...........(Owner and/or Contra <br /> c+or) ; <br /> G� _ .......(Title) ... ............. _. ... <br /> dowing ' of lot, loption of system in relation to walls, buildings. ate., can be placed on reversedd@J. <br /> ..... <br /> . ' FOR DEPARTMENT USE ONLY - <br /> r s � .... DATE....L. h7 <br /> »AK;APPLIC/iTION ACCEPTED BY .TsF^� DATE.._ <br /> ;REVIEWED.BY . ........... _ ....................... <br /> 4. :BUILDING PERMIT ISSUED <br /> ...�__..._...__.. i-GbTE <br /> 1. <br /> Alterefions @od/or recommendations...... ..... _. t...................rf•a.+.^'.1...._ <br /> Fv3 . <br /> ,J .P <br /> FINAL INSPECTI .� ....� Date.........�._I`.!J.. .G' .... ..- ..... vl <br /> ;i . . .... <br /> ' � SAN JOAQUIN LOCAL HEALTH DISTRICT <br />