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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMITPermit No. <br /> (Ceml,leto in Duplkehl Date ![wed <br /> • , This Dermic Ezciros 1 Year hem Date Issued <br /> Application ;s hereby mode to the San Joaquin Local Health District for a permit+o cons, end install the y/ehrk id�S� <br /> This application is made in compliance with County Ordinance No. Sh9. r �•r-d /� <br /> ''�� fir^ J - (�. /ti�if:l....�IT1 .I.�l.s'�. <br /> JOB ADDRFSS,AND LOC,AT+ON ..L•._S+I .._.?hiNL�.....rJi?.•_._I7. . ._. _ <br /> .... . Phone......_.._ .. <br /> _.... ..__._--- . ..... <br /> Address -. 1 v ;_...- ^:_......_._---------- <br /> . <br /> ...._. <br /> i . . :.lt....._....._Phone <br /> 1 laCJ2�1n _.. _ <br /> Con rector': Ndme -- - <br /> q p_eerdence Zi-, Pariment He se ❑ Commercial ❑ Trailer i .rt [3 Mole! ❑ Other <br /> Irnte�aflial Wel eerie= ,— <br /> mber of bat <br /> Number if.living units: _'--=..N+unber o: bedrooms. .. baths_.�.,. Lat�irx ....lki.�.-. -... <br /> Water Supply: iublic system ❑ Community system ❑ Private VT Depth to Water Teb!e-RC1, ft Adobe Hardpan❑ <br /> of 3 foal: Sand O'Gravel :lend Loam❑ -'&Y Loum❑ Cley❑ ❑ <br /> Character of se9.fe a depth ❑ Y . <br /> Prerrouz 4ppGratior+ Made. Of yes.dole.. -.. .....1 `No [J ...New Construction ,Yej ❑'r!o❑ FHA/VA:Yes�,Mo❑ .- <br /> TYPE OF INSTALLATIO0 AND SPECIFICATIONS: - <br /> (No septic tank or cesspool Permitted if public sewer i/'elraiwbb Within 200 tae+1, .i i7 <br /> Septic Tank: Distance from nearest wglL...;J.C� Distance from foundation XJ <br /> s Meseriel._l."S.l";�=il ��•��-�, <br /> t + Liquid depth..�L ��.........Capacity-4.- <br /> h.. <br /> apedty 4�7'� . . <br /> O No. of co AFl �r en .... . - <br /> - <br /> Disposal f-;e:d: Distexa from nearest_wall .�.<w,...Dis+ani f {ouPdation. ��-1...Dis+encs to neaten lot line ..�:^ . <br /> 'l f // <br /> Len th of each�ine.+: E �'`�idth of <br /> 0 ...... _ <br /> Number of lines._ ti> g < !' - Total len - <br /> >Type of:+ker ma+eneh 1�O �a.-Depth of filter material . gt <br /> .Distance to nearest lot L•ro _----.--_ <br /> Pr: Distance to nearest well D:stance irom'foundation .-..-.-- - <br /> - - Depth SLwp .-..._... <br /> ❑ Number of pih........j'.. .LnmD material.._......._.:.....Sae 4Dm.nolter ... .. ....... K <br /> ..:. _Lining materiel........_ ...... <br /> Distance from nearest well...... . Distance from foundatwn _ Liquid Cepeaity....... - gels. <br /> Pt :.... <br /> ❑ Sae: Diameter. ............ . Depth + . <br /> i . -�- l5 fence from interest building -- �3 <br /> Dis+enca from rest wee__-- -- <br /> Petry: �. .�i.,. _. . ........! . 1._�....._..._.. - .. <br /> ❑ Distance to eeeNFlot line.a. <br /> .. 1 <br /> nemodeling and,ror repairing (describes.......CO..ZA:A�:'jilYf..'�.-f{M l„.r)! �{.•`�{�...-..�I.;_........0-."0VT.N.�Of�.:a 4 <br /> �.' !'�...1...... <br /> GT....._--.....__� <br /> 1 here certify iMT I here Prspeou'th'n i ru-lion end ffiaf'lhs woh will be done in eccordanu With Sen Joaqui+. County <br /> ordinances, Slate laws, a rules and ry1#fions of the Sen Joaquin Local Health District. <br /> ...,., ,. .... (O•mer and;or C ontr t ac or! <br /> .......... .._.. .-----____ __..._.. <br /> B ._, Y _.._._........_.................a._.......... <br /> wells, bu <br /> ,Plot plan, ;Yav+ng yzs of lot,location of system in rel.ation to ildings+ etc., can be -=a on reversei s-=- <br /> FOR DEPARTMENT USE ONLY _ <br /> APPLICA?[OK"ACCEP.TED BY T':B-L' AT .. . ...... <br /> _ DATE <br /> REVIEWED BY ----_-...... -- .... -. DATE ... ..... .. <br /> BUILDING PERMIT ISSUED. .......-.-- 7 ....... <br /> Ntent+ars and/or resx:mm mclafions:-.... ti/s ..:.F .�fIFl/�G � 6J._..,3y��.C! ..'........1.�..f.7 <br /> ...--__-------------..._..... ...... ............. <br /> J ( <br /> try` 7' Date <br /> FINAL INSPECTION BY,.' c /( _ �r _ , 7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> A"- <br /> "a W[,+oh Sir[[+ 1U:Y[amu+Hn[+ 20S W. ilk Se«+ <br /> usaan <br /> I601 L nlsd6 CalUarnb Menu<e,Ce�;brnb TmrY,Ceitlarnla <br /> Srad4a.cenrwn <br /> as�a[�.aao eaa�`r roe rn ca <br />