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FOR OFF-CE USF <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complefe in Duplicate( Oaf* Issued �r - 1;?4;-�, <br /> This pound Expires 1 Year From Date Issued <br /> Application :s hereby meds to tms Sen Joaqu*n Local Health D;s`.rict for a path;' M corlhruct And-mila` f a work qra. descrbed. <br /> T6% sppl:citCon A made in compliance with County Ord"nsaceeNNo. 549. f� <br /> JOB ADDRESS 'Jvt},LOCATION . G.. d&L. .v t.OGYe LL f CQR G� r <br /> O.-„e-s Name / /�it� _ .... Phone ._... . _. <br /> Address. t-• . <br /> Contrecrat Nerne_ �� `... . _._ .. . Phone. _ <br /> WPA66ew w;4 saw”. Res;dence Assertm • House a Comrerc:al ❑ `wIv Court 0 Motel 0 Oti+w ❑ <br /> Numbw of v.n9 un:h Number of oedroo.ns .�# Number of ba•Fs y Lot size <br /> Wates Supply. cubLe system F) Ccrnnu;ty system r] Private wDep•h to Wa!er Tsb:e ft. <br /> Charter of wil to a depth of 3 feet: Send [2 Gavel E) ClaED loom❑ y loam Clay L7 ^ ❑ Hardpan Q <br /> Pmv:ous Application Made iN yes.do,* I No ❑ No. Construct, <br /> oa yes r-J No (-1 FHA/VA: Yes ',] Na r-- <br /> TYPE <br /> TYPE OF INSTALLATION AND SPECINCATIONS: <br /> (No septic fan& w cesspool permiffed if IaWAK sower is available within ?1181 feM.1 �•- <br /> Sept.c h �� Place f-om nearest well 'f0 i Distanr� os. <br /> from fro:}Per en /O Mnd-Iti-�rs.rs+C <br /> eeea <br /> U101Conr<c hrerts .� S::c.s //0�a(.5�.L•quio +saptn <br /> 0////) _ <br /> O�tpos r;c d L'i:ten:e from mearett well '!r0 D sw.ce from fr,ndat:on. /O Distance to neezett lot fine`s <br /> Numiwr of ' nas -.A-- Ltw9fl+ of each :ino /par WOO, of ""C' .2- f <br /> Ty-f-, o; i,lte• rnebr;al . 5, 2. Oeptl•. of ±afar mafe"e /.9 r Total :ength e7-.0.0... . <br /> See� P.t OnNroea to ryerrs• .oa /001 pntance f.om fzg`+ide•iCr -1040 <br /> ./-O40Owence to rroarcs' to- nc <br /> S� <br /> number v' F>,ts .'�. L n mater;e't S -1`. Sze: D'ameter Ai-` Da k'^ <br /> C_eupool: O;t•ance •iUm raaresr wei7 _ Onrance:fron, te•jndal kn L,•.ftq mntw.al <br /> '^ 0 Sine Dian•.eter Depth . .. . L•gwd Copac.ty qa-s. <br /> Pr ry: 7-slanca •rom roarev e h hon nwa•et• <br /> U 7'Vance to rewwt lot 7 ne .. <br /> Ramodelir.9 an.j/or moal•irg ldose.;lw;'.. .. - ... t� <br /> r Q <br /> I is raby certify that 1 have prepared the appi;caEon and tbaf the ww& wih ba dana in accardanca with $ae Joaquin Comfy <br /> erd;nences. Sta .s• and rides and roquiat;ans of the San Joaquin Locwl Health Oivf,K f. <br /> (S:q flal cam —W-fftrer and/or Contractorl <br /> fly: s/ <br /> (Plot p7en, showm9 sire of bf- bcet}on i 111410) <br /> of sy em in r N wells. blsRdings, etc., can be placed on .ewrte side}. <br /> FOR DEPARTMENT USE ONLY <br /> APP CA' :^_•"t ACCEPTED By A DATE. 6--A J-L> `^ <br /> REVIEWED B" DATE <br /> BJILDING PFRMIT }FD .. OATS <br /> A}Nratiom and/or rocemmendal:ons: <br /> FINAL lNS.afCT}OD! 9� e�/T/1.'�1��/, t� L�n•n6'1 � -/? <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT h <br /> 1601 a.q...n..•... no Www O.6 Sr...• 134 Srs.•wr.Y.s.r res w."vn.SA.«• <br /> !w►wn.Caki.... M/1.CarAwnN ara..w<..C.4...•w r.e�r. C�t......n. <br /> r✓�a - 1 <br />