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=USUE <br /> APpt,ICATION FOR SANITATION PERMIT <br /> Perna No. . _. ._ ,. <br /> has epbte In DuPk+*) 11i Date Icwed �� -3 <br /> Th s Perm E + a 1 Yew Freta Dost issued 1*4 <br /> Local Heillh Dist6kO for a pe`m:R to cy„truc4 and .natal; fila..Irk bwe�n deuribed. <br /> Application is hereby made Io the Sen.LoeePlin <br /> Tris applicator is mode <br /> W CO1" 'nmce No- 544. Q!J— /GO—Y3 <br /> JOB A17DRES5iha� <br /> � - M �f•� .-. r <br /> Ownem's Name _• .. . _ ' --__. ... <br /> •. ..- <br /> C"tis <br /> 6dabcAsr's New ss; �—�`�us ..Nmmber of b�etht . lot $wO....Mote: ❑ Other Q <br /> (',pmrMrcial Tramker Court <br /> Iedareliool will aarlro: Residanu Aver►of a Lias. [3 .?_. - 3.rri, 3 r!. - . .. <br /> Number of living units: ./ _ Number of badrooma .S' to Wetly table Y4 It. ._ <br /> Water Supply: Public system ❑ Cosh system ❑ Pr:veh pDO GLey Loam[1 Cby❑ Adabo Q Hardpan 0 <br /> Ck.w of sal to a devA of I hat: Send d C+ravel 0 Seedy 0 r'r <br /> I No ❑ Now C.onstnktioo: Yos U Ko ❑ FHANA: Yes 0 <br /> Previous App$estior Made: Di yes,dose .� <br /> TYPO: Of INSTALLATION AND SPECIFICATIONS: 2 <br /> available fats(_. 4- - J <br /> (tVo saFAic lore;a ra'sWool Mrmittad-N pn6Gcuwaravailable n1tWn 00 •� T <br /> PIP <br /> .N.etwial <br /> ,y O�. Distance IrR m ewndeti" /Q r.y,f/p•O N <br /> Soptic Tank- • 04lance from nc+nrast we+i •:c'i2e 7+�r?S.Liqu+d &Vth .. Capacity.. �. <br /> Na. o! eeenperUsarls?�- _ /O. Dittarca to noerest W lire.r� Z <br /> D,sposal F'.old' Distance From nwrast weal SO.�... �e^gll+ Of each 1 o from '�O,.:a. W,&S of trench <br /> Number of Lou .ti3_���.,,,��� ��j Total le^91° <br /> Type of filter meNrialYf"� ..Deittff of filter.matwie- .. <br /> II// �....._.... .Distance to mva- %t lot G.w <br /> I Seepage PA. I Distance to nearest are' -. ,Dittanut from foumudation - Death <br /> E3 4 Numbtr of pits- L;nmg malarial. ... . _Sika Diameter - <br /> D;sterce from reote%t .00 -Distance from faurdation Lin:ng material yp <br /> Cesspool= . .. L,,qu:d Ca"COV 90' Sr <br /> S:re: Diameter_ Depth <br /> 7"tance from nearest .rag- -. Dntanct from nM+Ost twild•ng. .. ' <br /> privy: . _.. .... . _. -.. <br /> D <br /> • Ditteroe to nearta/ lot line ._ _. .. <br /> ...... <br /> Romadeli19 andlar ray.sirinq {dasrhbaT, .. <br /> I ncsrad Mfr• •PD t tatien and that Ilse wools Mir be done w accordareo "A San J"quin County <br /> . certify chef f Iuvs papa <br /> ordinances. Slate and .vLs and raqufalwrfs of the San Joaquin Local HOOK Dfskitt <br /> r00T �/./ _- (O..nar and/or Conkactorl, <br /> (Signed) .. ;LAD •w. _ ��I -t`_ .+.� <br /> b w•Idmgt.y �. akc., toot» on rrvt�w *idol. <br /> (Ffot Plan. fee of ler.kstatian of min rotation to welh�bP .. <br /> r 1 s FOR DEPARTMENT USE ONLY <br /> APPL:CAT(ON ACCEPTED BY <br /> . DATE <br /> REVIEWED BY <br /> _. - _•- . . ._. .. � DATE. . . <br /> BUILDING PERMIT ISSUED . - <br /> Ahooa/iees end/or wowflefeedeiwm:.. .. .. .. ... <br /> FINAL :NipEcric)pi BY. A1111n <br /> SAN JO/6QUW LOCAL HEALTH DISTRICT <br /> 70o v/.a Or 1**" �•s1.a.+w. <br /> Iaet 1.11e`ah•e AveWmws..CdYr•r.:• Tr•v CM:h.++ <br /> psdt•a,c„saasraw l.r.CM:h.wea <br />