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�I <br /> 77 <br /> N <br /> rf i FOR OFFICE USE ` <br /> :... APPLICATION FOR SANITATION PERMITPermlf No 3�G � <br /> r r_ fj s`y;rt <br /> [Cemplety i- Duplieafe) ssued! <br /> b' /¢ <br /> L1r <br /> r ............... ued Date i d lt7fJ 1 K <br /> This Permit Expires 7 Year From Date Iss <br /> Applica+ion'is hereby made to the San Joaquin Local Health District for a permit to construct end install the work ascribed s' i <br /> rThis application is made in compliance with County Ordinance No. 49. l <br /> rJ <br /> t JOB ADDRESS'AND OC i 1�- .ti`�._..e.(I/IP <br /> .. .. {y s <br /> L <br /> Owns s A1ame ph......: <br /> Address. :... :i' ..r ,ll�/�FL ....� r <br /> 4 Contractors Narrla ...._ -. C.� Ai�.C .......<........ Phone <br /> Installation will sews Residence ❑ Apartment House Commercial - TreWer Gourt Motel Othar �� a <br /> ❑ ❑..... � <br /> Number of living units: ..`.... Number.of bedrooms_�r:- Number of baths Lai size y�tGh>d ' <br /> et Water Supply:: Public.system ❑ Community system ❑ 'Private �epih to Water"TablefQ ft <br /> r: Charecfe�of soil <br /> to a depth of 3 fce+ ' Send❑ Gravel❑ Sandy Loam�Z°iay Loam ❑ Cley❑ Adobe©rT Hardpan E2 <br /> i as Praviou: Apphcatian Mede: 11f`yes,aate........-:........- } No R'—`New Construction: Yes ❑ No'�rFHA/VA Yes <br /> a <br /> k,. <br /> TYPE',C INSTALLATION AND.SPECIFICATIONS: <br /> t i'Jo eepfie tank or eessponLp rmiHed if public sewer ;,*vat <br /> wifhln 200'feef� <br /> i 4 St^pi,c Ta lit•' Cllstan�e.from nes esi.�+ell Distance from foundation.... Ma+enal �� <br /> k'' •�f!��'`iC - No.4 t compartments ..............Biz _---..._._... Liquid depth: capacityr ?hr; R <br /> Dispose! Freld Dis+anca"from neares °,e-ptO,,&...Distance from foundation.. .�Distance to nears lot line r ^p•, <br /> k �/ : Num�al?•9f lines Length of each line.... �V,dtli of tren � 3Cj <br /> ,+� Type of filter+erl .moi Depth of filter mater;al �rip,.Total length 4 <br /> } See .011 <br /> page Plt NumDisfber of I+s res sll r` Lac Zs ..'Distance Taall}t fou}ldS•rze�Diemeter +o Deef>,s <br /> a Q� P 9 �j p- <br /> "r_ Cesspool Distance from neares#wel Distance from foundation Ltmng me'enal$• <br /> 1 ❑ <br /> Size. D;ameter. Depth ...................... Liquid=Capr Ity` .gals�d <br /> x. <br /> a Privy w Distance from net res! well.....................r.. Distance from neares+ building "p <br /> ❑ stance to nearest lot line ......... <br /> 4 D1 <br /> h <br /> h Remodeling and/or repairing (describe): <br /> : ........:. ..................... ......... ..........- t�q � <br /> ✓;- _ - -_ _ - <br /> ...................:............:...........: .... <br /> L <br /> i7 <br /> ..:..,.y ..................P...p--..... '.:....._....................._............ ........ ..:. .:q � <br /> { I herebycertify that I have prepared this application and that the work will be done m'aecordanee wtfh San Joe uln Coun -s, <br /> y, ordinances, State laws, at d rule and regulations of he San Joaquin Local Health Dlsfricf. <br /> ,-.(Signed ... <br /> 4-� <br /> l Y:.. ..._.... ....................:...--:...: <br /> x r t <br /> _ t <br /> i ( p g y ngs, etc.,,can be placed an reverse.side}. <br /> Plot Ian, showing sire of lot, Iota+ion of s ste re anon fo.wells, lruildi <br /> FOR DEPARTMENT USE ONLY c`' i ,•':r� x <br /> 1} APPLICATION ACCEPTED UY./ ,-/V ......�✓ :::.:;s �.� ^!. DATE <br /> REVIEWED BY......... <br /> ....................:..-.-...... .-...-..:..--..-.:......-...... DATE r <br /> BUILDING PERMIT ISSUED...................... f .......�?1......... h-s��c.�i3�✓-:.:-DATE.. <br /> : _ 4 <br /> r <br /> i <br /> > - <br /> Alterations and/or recommendations:............. s 'f <br /> I.. <br /> ...........,........................ ........................--....F.jih.lV(........_.. ......t.`.'......- �'3c7..r.. .. ...... <br /> as <br /> ....................................... . '--' ._..... ................................. <br /> ........ ........................................... .. ............ .. ............... . ......... <br /> 3, <br /> 171. <br /> , G <br /> FINAL INSPECT:G s BY:-... -M .£! Date..... 7 .:—��...�0 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> -1601 E.Haselten kee. - 300 West Ono Sheet 124 Sycamore Street -205 West 9th Stroll <br /> SFeckten,California - Lodi California - Menteco,Cnlifornia s. _ <br /> t 7idcY,California <br /> - E.H.9 2M 1.47 Vonyvord P::rs - - - <br /> I <br />