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FOR OFFICE USE: permit No. <br /> z- 4.;, APPLICATION FOR SAWAMN PERM Date <br /> panspleft;n Dupkaft),te lswiwd <br /> TNMS P6 11 Year From Date rib"d <br /> tmci ai,cl;-stal the o.k herein described. <br /> In Local Health District for a M`-:I to Cars <br /> 'aby <br /> tied <br /> A, <br /> t <br /> to <br /> a I <br /> In <br /> Applicaflon is Son joxqu. <br /> This application is made," compliance with(-,,,ty,O,d;M,ce No.-549. <br /> _-.— <br /> /,/S, e76 k <br /> S D LOCATION ftorse------------- <br /> JOB ADORES <br /> .... - ---------- <br /> ownees Name. ......... <br /> ew-4:41. Phone-, <br /> Addre"......... <br /> wo <br /> Other NNz <br /> Contractor's Name.. C] Trailer Court 0 Metal [3 <br /> �Aprtment House E3 Commercial Lot size - S4 ------ <br /> Instaget6n A some: Residence Number of bedrooms- Nu,be.- of baths <br /> N'Mber of living units: .. Private[9�'Dpth to Water Table W it <br /> Community system 0 1.-0 C, y[3 Adobe a-Hardpan C3 <br /> Water Supply.- Public system 0 Sandy Loam 0 Clay 'a <br /> (>.ffaidw of 01 #1&depth of 3 feet' Sand 0 <br /> Level 0 Yes 0- f4o 13 FjjA/VA:Yes 0 No 0 <br /> 1 No[�r Nev,COr'structlo"; <br /> Appr <br /> see,tion Made: (if yes,dote <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ..is&veaslate within 200 fee.) Material.05� <br /> ptk tank or Coup"Poon"Ilod 'f P'br"f 16..'_ <br /> 11 -'C Distance item foundat;"' +d / , <br /> (N D411ance from nearest '� id depth ( ty � <br /> Septic Tank- S;ze. 'Uq' west lot line—t'51:1-1 <br /> of compartments Dislame from foundation- Distance to rim ------ <br /> �-e of franc) <br /> Distance from nearest .,gth of each I;nc 'yof_- Vlkith <br /> Disposal Field, U To"I I"Varlh- <br /> Number Oi I;n-- c_k;Depth of f"It"r material ­-5------- <br /> Type of filter m.t,,jaj..45,/? <br /> L e, 4 f j.1;On t tot line. <br /> Distan.t4 to near" <br /> Depth �X:.i".:.....--....._ <br /> warest.0 D411amoi-fin, me <br /> Seepage Pit: Distance to V Uling r lroc_,ir 1,;,,: Die to, ...... <br /> Number Of Pit, / Distance from fcunda#;Oa linin material <br /> Distance Com rivaroo .01 Licl,;d Capacity ...._..........--go <br /> Cesspool: Sim: Diameter. Depth. ta�ce flo" "O"'est building ................... <br /> 0 Distance from Ma'ast �11 D,s .......... .. <br /> Privy: <br /> 0 DMis,iCit to r"re"t lot 1're <br /> Remodeling and/or z1`7 /1� ............'................... . <br /> ....... <br /> ... <br /> ... ... ith San Joaquin Countj <br /> o and that the work w;U be Jona ;q accordant 1 w <br /> Certify I have WSPOrOdl#his &PP';C't;c j. - Local Health oh"cf- <br /> ' the San quo <br /> Ord* w '7�gtafion% at ') to and/or Contractor) <br /> 14 <br /> (vto) <br /> AZ side} <br /> (Sired) j,9L ot,czw be pli"d on rev* <br /> � I F"'; I I . <br /> Id <br /> By, f to 4tion to-elk. <br /> n'soklo�wlwnsg ska,OF fail.location,a Sys w <br /> (plot P6 <br /> FOR DEpAIkTI,iEMT-USE ONLY <br /> DATE <br /> DATE <br /> APPLICATION 91 DATE <br /> CATION ACCEPTED B'f <br /> REviEWED By ........ <br /> BUILDING PERMIT ISSUED .... ........ <br /> AIW,.i;,Os and/or r ..r <br /> ju <br /> J -Lf`-6/ <br /> NSPECTIOTI Sy: <br /> SAN.JOAQUIN LOC',L HEALTH DISTRICT 201 W--'9'% <br /> 100 W."Ok <br /> C. <br />