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MOW
<br /> APPLICATION FOR SANITATION PERMIT
<br /> (Complete in Duplics+e) '...
<br /> ...., Dore I Issued
<br /> ', •- --• ,f
<br /> This Permit Expires I Year From Date Issued
<br /> �piicat;Cn :s hereby Mace ro the Sdn Joaquin _I zcal health D;s-ric- for a =er-ni- l0 ;ZnSr QnC ^rmji ri%s wont her?ir: ciesc.'bed.
<br /> apaiiea+lon 15 ::•race ;n zomai;ance with County Ord;nence No- 5a9 ��c� ���E �c:'.G.'.� /':�ca :e/ �' -•.•G r'-.
<br /> �/•• ,/// /��ti / •r .jib i;n• -r/e/
<br /> _CB ADDRESS ,,N � a}ION...---...,-��.>��t,...1..... . ..-..- �
<br /> _carter s Name_..__"...._- ........ ... ..._,• .... ............
<br /> Address,_,----- Ic -W ^�� ----- , —-----------_----- _..._...__..
<br /> ----------- ------------ Phone.---;'/e
<br /> _Jnrrac.nr s Name-..'^•�G�`��.�.�--.,..-J;x,.... ,:-•--
<br /> '.nstalla+ion will serve: Residence 71- Apar+ment House ❑ Commerciai ❑ railer Cour+ ❑ Motei ❑ Orher ❑
<br /> Number of fiv;ng units: ..., Number of bedrooms .., Number o: baths /.,x 'r size __ c�.�r,4�0- •----•••--•NPpa+ar Su (Y: PuoY;ic s stem ❑ Community system r-1 Privote C1Depth to Water Table /� ft.
<br /> Character of soil to a depth of 3 feat- Sand ❑ Gra-el Sandy Loom X Clay Loam ❑ Ciey ❑ Adobe❑ Hardpan [
<br /> al
<br /> Previous Application Made: ;If yes,dere. .... ..........1 No j3 New Construction: 'Yes C] No 0 FHA/VA: Yes Z: No
<br /> `1'PE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.}
<br /> D;stance *rpm r•oundation--------------------Ma+eriai._......__............-- ---------------
<br /> Septic Tank: Distonca rom nearest Nafl...-- ..... Capacity................._,.,.
<br /> ❑ --------------------------------Li uid aeoth..................... t —,..-
<br /> No. of comparTments..........................Size4
<br /> Disposal �,eid: 0;s+ence-*om nearest_«eil__._=: O;stence from ioundation.y� --..•Dis'ance b neer®s lot me _
<br /> �+-- --r--. ,. W;cth of rench.,...��.-----------•--
<br /> r� Numoar'o► �•„••...v- Lengin o* each ,rne...lGr
<br /> �otei len th. •--�f '�................
<br /> Type o;filter mo+erial..� �GY� .-Depth of Filter material_.,. __.......... 9
<br /> Seecage Pit: Distance"to nearest'wail......... ---Di�a Tr Distance to nearest lot line_-.-_-__------- C
<br /> (— Numvai pass., T _._Lining materrai......................,Size: 17i4meter_,--
<br /> Ag tal_--.'... ----..•----
<br /> Cesspool . � t� ''O^' nacres+ well..--_---.:,_,_.Distance from roundation....................L'miterin
<br /> -
<br /> _,_.-.-, ....
<br /> L uid
<br /> ------
<br /> Size, afar----.-
<br /> s building..
<br /> uildain
<br /> 9
<br /> Priv D;stanelfrom n9eist Nei... ....,. ,,,-......... f n nearer+ a
<br /> �
<br /> I.--------.. - ..., - -------•
<br /> Distangto nearest o ne --..,,,_..... ,
<br /> ❑ ..gais.
<br /> ct
<br /> ,iarrodeiins end%or repairing IdeSCr�Je):.•.-_-
<br /> - -
<br /> ---1 Y ----•••. - ---,
<br /> s ---
<br /> ...
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<br /> -----------•----_-_ --....,- ..-------•---------------•-•------------------
<br /> ce that l have prepared this application and that the work call{ be done in accordance with San Joaquin pun
<br /> 16ereb \
<br /> ordinances, State s, and rvla't.and regulations of tib.San Joaquin Loral Health Distric'
<br /> (d ner
<br /> nallor C ntract
<br /> ;Signed} ( Itla) ..... .. ..............
<br /> tern in •elation to wells, buildings, etc„ can be, placed on reverse side-
<br /> Plo+ plan, showing size of lot. locati syr
<br /> FOR DEPARTMENT USL2 ONLY
<br /> J ----•--
<br /> AR13O ICA i IC N ACCE'TZ-? 3Y.._., G,._./.... _ •- _. .,. I ..,.H -• 0ATE._--_„---- --- ... _.. .._. ••--
<br /> RE'-iIEW1-:D g ......................................_.,
<br /> I LDI NG PERMIT ISSUE-D --------•-..+...------*-----......................
<br /> Alterations- .............and,�or!. ae need..•......... ........• ._...-----.•._.._........ .., ... ...M ...' - •... V., ,.
<br /> . .............. .......I........ .._.,.....__.,. ._....._...�f J,i.-..._....• ... __...._.. Ja s... .. : '�.. .. ........ . ............. .......----•---•_...
<br /> ,.-. . .
<br /> SAN JOAQUIN LCCAL HEAL-H DISTRICT
<br /> t bel i. MrsollNn Avw. 400 W.•e Oelc SHAM
<br /> 124 Svevn+ore Srrwr 205 Woo vr* st,"t
<br /> lndi. :ul:fomia
<br /> Mon••co. CeNfornro rreor. CaFiornio
<br /> S.eck+.n. CsliN•nia
<br /> e72Z;
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