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FCS OFF CE 'JSE I <br /> AMICATFON FOR SANITATION PERMIT Pam* No. <br /> (Compk►trin Dugmafe) Dere Istwd.4!;�.:1.:1�, <br /> This Petrnit Eaeire► t Year from Date Issued <br /> .�•.plicet;cr s 1•areby -rade •o fie Son Jooquin Local Hea1M D10i,ct for a Ferm.t +o tonstruct end ;ental)the elarL haroiN dese+rbed. s <br /> ac-: sonoa t made it compliance with County Ordinan <br /> ceNo- 540. p p <br /> -OB ADDRESS AND LOCATION ws44rs "7 Kfr+��Y hA esu �.._ .1►,0t_ <br /> Phorrs <br /> p �y <br /> '..'o� ret+o. s F:a•r+,+ 64r�✓+� _C.4''`-'`• � ,�iY'yh�. ..__. Phone_. _ ._. ... . <br /> InsraBatioa .17 sernre: R•6do1nca Apo rtmenf House ❑ Commsrc;al ❑ Troi�/ler Co+r+ E] MOW. (] Ofhr 13Number of I;vmg ufwts: Nurnkw of bedrooms Number f baths ..i! Lot site <br /> t <br /> We" Supply; P,rbl;c system (7 community system (❑ Private DeptA to Wetp take . {t <br /> GI•roeor of WA Ito a depth it 3 4e1- Sand 0 Growl E3 Sandy Loom 0. Clay Loom eCIey.O Adobe a Herdpas❑ <br /> Prey ow AppGcafion Made: Ill yes,dote I No ❑ Now Cor+stwetiorn: Yes Q No Q FHANA Yes D NO Q <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> 'xed i! pobre rewar,is avarill a fftsia 200 4a.) Q, <br /> (Ne septic tank a cesspool perm. ... � w <br /> .`-.1 '. <br /> Sect c Tnnl D'stance from nearest weal Distenca from foundetlon_., yyet•r;a: _..__.-___. _. . <br /> .�+,�.' <br /> J No. of cmysartnsents... . .. 5i» _ .. . .. _...Lquid depth. Capsuty_, .- .._. <br /> Dsposal Fie d- Didence from ,woo well 9istance frcon foundation Distance, ro more lot line . <br /> ❑ 1 Number of ones _._. ._.. .. Length of each lime. L;Q01 of trout+ <br /> Type of triter mate-;a! Depth of 411W matoe;al . _.:.. .Total klra t 1 , st� <br /> .S •-W- ... . _. <br /> +� D.stancs W noanu ws:1 .IOB ' ...Dlstanee from fountlatiorn..,.10"......D�sfance to neo•est Lot li'* .�y <br /> (� Numbar of pts /... . .. L:,-;.,g mater-al S.A- . Sia: fa..e►..1 X -.I.: Depth /S ....._. L. <br /> Ceupoel: Disiencoce from nearest well Distance from foundation Lining meferieL. <br /> E] Size� Ekameser. _ .-_ Depth Liquid Ctopeciti, gals <br /> Privy: I Distence from Warost •e3 .. Distance from nearest building. . <br /> ce to Poorest '�e <br /> E7 � Ds+en <br /> Remodeling end or:4-ring Id4xr7ao) . w <br /> ... <br /> I Mr.by certify thit I loiw prepared tba application ar•d +hat the work wit be done in oeordeam wWh Saw Joaquin Cau* <br /> ordinances. State taws, d' and regulations of Oise San Joaquin Local Heafth District. <br /> (Signed) r f .. Pevai.awd/or Cmekootr) <br /> By: z <br /> �(pio+ pie", shown q si» o! b! locdfelt of sysrelwMsn to elh, build;ngs, efc.. can be placed oe rectae lido} <br /> FOR DEPARTMENT USE ONLY <br /> APP:KATION ACCEPTED if, . . - DATE. / 'f-G 'J . ... <br /> REVIEWED By .... —11 . , _. _ . . ' DATE <br /> BUILDING PERMIT ISSUED DATE . <br /> Alterations and/or reeempon," iena: _ ... ._. .. . <br /> t <br /> FINAL INSPECT"4 BY: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> TNI A.wesatn.M.. Do ww Ors srr«I 114 srr..nfw.St.ral ton w.0 wf.Ifrr.l <br /> . sae. C.f:l.rw alenr.e.,CeaWlariw. Tr•rr,ta.A.rnM <br /> tM I"146F Vw.euN►r w <br />