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FOR OFFICE USE _ <br /> APPLICATION FOR SANITATION PERW P«m%t No. <br /> (Complete in Dvpicafe) Date Issued /,0 <br /> Th.t perm,# F.awrs i Year from Daft Issued <br /> A--pl,cation ;s hereby mea to the Sae Joaauir Loco" Hadth JD sr rict for a oO construct and install the herein•das[r+y�d <br /> �`3-o d—ZG <br /> Tn: a �cetr ,s .ro�de�n corn ar,.c/c-+. n� :.:aunt♦y C7ndinnnco No. 54j�V.� `� <br /> JOB RTSS AND LOICn .rj'o /7�/1�ri 14a'.��'...e <br /> Ownon s Nome 1, +'. ... // ... .. FnOne ... .. .. <br /> Address 311 t <br /> Comrretsor's Name__. .. a .... . .. _...- Phots_. . ._ .__. ...... <br /> Installation will serve: Ros<dence Aloartmea P Howse 'Z1 Cesm rorcist ;] Trailer Cowl ❑ Mohs 13t?�OWJ'J�]� <br /> Numbw of I:vi" untts .A Number of bedrooms 3Number tat'7"Zo! tum /•JWPOO U - <br /> Wotar Supply: Pullok system 0 Community, syc!em [3 Private 9, Depth to Toble it. � <br /> Charade,of aoi to• depth of 3 foot: Sand C] Grovel 0 Sandy Loom Clay Loom E] Clay ❑ Adobo E3 Hardpem C � <br /> Previous AppGeation Made. III yos,dofe. } No Q New Construction: Yes Q foo [j fHAlYA Yes Q No []' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> )No septic tank or cesspool pommod if Public aewor is waiable wiMie 200 feet.) I <br /> I <br /> Septic L' Distance from nearest we ISO . .Diston4a from foundation /p. tNeter'al . �i►+•�. <br /> No. of compartments .'fes Si efl��XQ�!(.3S Gq,id depth 4" .C.eoec;fy /ZO• . . <br /> 6s old: Distances from nearest .all, JA` Distance from, feundaf;on. C Distsnco to neerast Sof frets v <br /> Number of fines . . s Long* of each time $'0-0 Width of trere'e. A-� <br /> Typo of fete• Dopth of fetter Moser.al, /f.~..Tofat 10n9ti' n.Z#YO <br /> Seepage Pit: Dlttance to nearest wet ...... _Divance from foundation ..... __ . Distance to naarasr ;ot Lme <br /> 0 Nurnber of p-h Lining mate*;&,. ....... Sime Mametar ..... .. Depth <br /> Cesspool: Dis•ance 4 cn mooml weft ...._ „Disforce from foundat on Lining natarial,._.. . ..... <br /> 1 C Sita: D.anoter.... Depth _ _'. .. . Liquid Capacity. . ge1Al' <br /> Privy: Distance from newest well ..... D'04rce from nearest bu,w;tq <br /> n. Distance to nearest '04 {CN __.. _... .. ...._.... . ._. __. - V <br /> f 'r. <br /> lRernodelinq aril,+or ......... ,_, ........ _. ..., .. .. ....... . .. _. _. r <br /> ' 1 <br /> +; <br /> I hwoby certify that t have prepared this appkation and that the week will be dono in accordance wink 0 JOayvin County <br /> ordinomcss, Sime laws. niers and raqu4tiam of tern San Joaquin Local Huehh D"estricC <br /> )Siepssd) nd�Or cofttrae•orI <br /> llr <br /> (Plot plea, shts.ing tae of let, bcetion of sysfett in relation to woUk 6044m^ etc., can be placed on rwoww i&d <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By DATE <br /> REVIEWED By _ DATE ......_ <br /> BUILDING PERMIT ISSUED..... . ....._. __ __ DATE._ _. <br /> Alterations and/w reaaffeesedationa .. . . . _.. . .._._...... .--.... .. ...... ..... ... .__ . __.._. <br /> I <br /> 14NAL.INSPECTION BY:. .W��W,01. Dote <br /> SAN JOAQUfN LOCAL HEALTH DISTRICT <br /> Ieoi a.ltanYae Ave. 3"wast Oaa s..wn 124 S".w li « !os w..r <br /> Sudden.cowensY tat•.cWMwsw uwae•caller -io fixe,G'.Iwnla <br /> r Hca <br />