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FOR OFFICE USE <br /> APPLICATION FOR-SANITATION PERMIT Permit No. ;_Z1YA1..._ <br /> (Complete In Duplicate) Data Issued /®r'a.d..-tG <br /> + This Permit Expires 1 Yew From Data Invited <br /> ltl.w Application is hereby made to the San Jeequin Lo=af Health Distract for a oarm t to construct and irtttal Ilse work herein dotctbed <br /> Th:s �jjr •;n a aglt�County Ordinance No. '5x9. �T[(� <br /> I Jos ooRESs ANo i AT D>* "Wy1 .12) 0 /.� ,, W aF .. l.....RtPON . RD. <br /> f,'jrna-, tJerre .. . . oi711I. ( DE.Dt.N:( /� <br /> Addrost _. �3TE ..._-..1 -- ... 266 . __. .. RiFlo _.* . <br /> Contractors Nanta....., Q4t�l.�Fm"ll.. ' . _ ........_...... ._.. <br /> tnstellat; n will sane: Residence Apartment House ❑ Cornmomiol ❑ Traikr Court E3 Mole& ❑ Other ❑ <br /> Number of Iivting urwA: -�.... Nun)cr of badrooms 3.: Number of baths' Lot sae rAc R MA G F, <br /> Water Supply: Public syttem ❑ Colne+unity tyttom ❑ Prvete Depth to Water Table a it. ..-� <br /> Character, of soil to a depth of J fear#:11,Sand ravel❑ Ss Loam❑ Clay Loam[] Clsy Adobe❑ Hardpan ❑� <br /> Previous Appikefien Made: IN yes.dote I No nNow Comtruct;on: Yes ❑ No KFHA/YA Yes C} No a <br /> TYf6.$ZE_,INSTALLATIOM AND•SPtEQMAMNS: _ _ %A <br /> (No split feel or co"Pool Permkhd if public Sewer Is availl able within 2001100.1 <br /> Septet 1 0-stance from r!eorctr wb S,t`.7_D"ntonce Tram {ou�detion. 1O Mtafrar:er.CQ C�+ i...T•�ss►.._.. <br /> No. of con•partmanh. .� . . Sise,.41A?0,X_5n:...L.quid dart" T� .Cepacity__+�210 Q. <br /> Da rose; Id: Distant* from nearest wall O 0a!ance from f ♦ <br /> t t � Oertdafipn. ,/IIA Distexa to neerast lot litr�.,�.�.".., �' a <br /> Number of linos_. ..... 2— to"9A 0; each line ] g� Width of tror!ck.....114 <br /> Typo of C-6' ;net O';af. �oCK.. Ocpth of filter mator.al Tot** 4 th aa <br /> / �9 4ray /D171./....._.' <br /> G I rest woR, fr 5 . .. .Distance�:Ian* foundatron....�Q...._ . Drs*any to r!aarotf tof line <br /> Seepage Pu: Ddtavclg to non: T�"`h <br /> NFnber tO pits.'... Jr Lining matariel..P1QC�• •Sae- Diameter .,3X apth �''...g <br /> I <br /> Cesspool: Drtrance from neerest well Distance irom foundot.on Lia!ng materiel <br /> ❑ Sea: Diameyr t _. . .. Death ....... L.-;aid Cepocity _.gals. <br /> .`. Pavy; Mstaxe from resresf'"I _... Distance ;rum neo-014 b,:,dir.g <br /> Disfirce to rdZ4Kt •.pt <br /> I �EN2*iN tf-•• _ <br /> aemo"ing sr.dfor rorliinna Idescribc: ADD TD <br /> - . . .. . _. _ t _...._._.. <br /> ........... <br /> I hereby cart fy that I have Prepaiod th;s application and theit the woe It in n'lf be done M ace orderum wink San Joaquin Covny <br /> errMrancrt, <br /> $tat* laws, and rubs and r IaNer» of San Joaquin Local Health Dislrid <br /> (Sigrwd)!t/ _ .. r ..,. - .....__ IO~ and/or Cenrractorl <br /> lly:.. ., . ..... <br /> IP61 plan, showll4 aid of loft, location of system in rolHian to wells, bu"Ings, ark., can be p1mad <br /> on reverse t+d0 <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.. . T.. ►3.O r .. . . .-_ ..... __. . DATE 2Q_+7 •.. .. Z. _ <br /> REVIEWED BY _ DATE <br /> BUILOtNG PERMIT ISSUED .. _ ..... ._. DATA- <br /> Alteratieat andjor tecommasdafkA'.. . _._.. .. _. - . _. ..._. . .. <br /> t <br /> FINAL #NSP La!/ Own— ✓/Oo le — /Z/— X46. ' <br /> t <br /> 1,%., SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1Nt A.Mier Aw axe w.a O t tw«. 114 fr..w.r.t..«. 71Dt W.,•ia,t..... 1 <br /> iratala.L� lrs.•, CobM•.4 .Mr..u, Ca1+H.nr u.y,Gbrv.,.. <br /> 1 <br />