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FOR OFFICE USE: I <br /> . -...... . . .. "Iliad <br /> -- APPLICATION FOR SANIIATION PERMIT Nrenif No. <br /> /O <br /> !Cample'y in AuplieaM) <br /> issemif Eaoire. I Year From Date Issued ✓--1✓.-c�r� <br /> 4 y' APPlica}ion n heroby made to the Sen Jae ..._. 33 OEM Issued <br /> f(' This eppHeetion is meds in complia wishgCou Ordin.anlee�No�549r a'}fermit to construe}enc)cins{eh{I{a work herein dritied. <br /> `. i JOB ADDRESS AND LO AT��S-••:..,. R <br /> ! + JSMAt.c,....... D... .ia <br /> o«nd/f Name........:. �L�GK........ rl....?su So......FR>wfV .�ivin .:. _... <br /> N........... 1 <br /> - Addross—.._....... r� - � tphone v, 7.. 8..: M.. ...c.R... :............._.............. <br /> Contractor's Name........O.WNp „,,,,,,, <br /> s � <br /> Installation will serve: Residence A artmenf House - -.._. -•••”"""""'"' Phone..._ <br /> ...................... <br /> - L9`"P ❑ Commercial ❑ Trailer Court ❑ M�tl ❑ O%er ❑ <br /> Number of living units: <br /> 3� .. ... . Numoer of bedrooms. .- Number of baths .�List sire ....f 1 <br /> Wafer Supply: Public systom ❑ Com•nenify .system ❑ Private (�Dapfh to Water Table'A-5-ft'. .. A' ..... -•-.- .- -.-_...- . <br /> Chander of soU te• depth of 3 bet:, da d.<_- ravel❑.-Sandy Loam❑._C!ay.Loam.❑.._CI y� -Adobe Cl Hardpan❑ <br /> Y Previous Applicaffan Mada: [if yes,dote �" "' "" -'--�• <br /> - .. . ) No New Consfroction: Yes No LJ <br /> FHA/VA! Yes p� No❑ -' <br /> TYPE OF INSTALLATION AND SPECIFIG\ATIONS: ` <br /> i (No sep641'enk or cesspool permitted if public sewer is available within 200 feet.) t <br /> Seo}ic Tank: Distance from nearest well...Jr„'s7.....pistane from foundation..( ... ....M��sfara REDy(/(��j <br /> Sao.�e�.'f.Q,,:Ys•,Liquid <br /> depth... Capacity... Cepauty /2.00 <br /> Disposal Fuld^' Distante from nearest well. JrQ Distance Pram `oBunnedatio.:n...7./5Q.. iO'stenc <br /> sneerest�lot 4.1 e Number of liner_......,3 .....Length of each :; ;dth kench...ype Y <br /> H <br /> or filter material of filter mate �.�....�.. ..Totel ii!l <br /> h ,�y _Sn-epege Pit: JDistance fo nearest well........ ..........Distance f om fou._ ,� -•- <br /> iq -. Dufnearest ineT ❑ Number of Pits.. .... ... ...Lining material. S, a D,a saferanD -Tepth..,lo____... _. . }Cesspool: Distenc frornnearesi wells C...........Distance from foundefwn. L,mnienel .. <br /> ❑ Size: Liamefor .. . _4." ...... Depth. ._.!.... i. ............Liquid G pacrty. s. <br /> c1� <br /> Privy- Disfonce from nearest weU.. .. Dis'a�r; frr. neeresT bmld�n <br /> g <br /> ❑ Distance to nearest os 1 ne_.., .. . ,+ 1 ........._.. - ...... .. <br /> 9a <br /> . ....... _.._....f�r ...... <br /> 17 I <br /> Remodeling and/or repairing ldesu't•l 77KJf>-. Lfly.L�. ...Lis$'�• TrESrA j <br /> _ .........._...._ _..._................. d -. .... <br /> ......................... .................. ........... ..... .... <br /> �A~..1............. . ...::.L..i.- s I <br /> ... . ..... _....._ ...... ............. ............. . �, 471 t ._........_........_.....................- <br /> I hereby certify that I have prepared This application and that the work will be done ,n accordance with San Joaquin County <br /> ordinances. State I ws, an miss and/rogy6fions of the San Joaquin Le Health District � <br /> (Signed)...... .... I. /C!M'h.J. �... . ............(Owner end/or Contractor) <br /> r .... .......: <br /> , <br /> By:.... ........ ............._........... <br /> ......................�.........1..................................................(Title)......... ... <br /> ......... ......_...._.... . ..... ....... <br /> (Kat plan, sho ' g sise of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> is - ------ -------' <br /> APPLICATION ACCEPTED BY... .` 7;K0 ,-----------. .. DATE.....L-.4....—.d6. ... <br /> -. . ' ..... .... ........ ......... <br /> REVIEWED BY__.................... ......_ ..i DATE._. ................... <br /> BUILDING PERMIT ISSUED. ......, .. ._......- <br /> REC . DATE... ... - <br /> Alfevtro w roeommende+'ons:.ieand/or _ / �y 6C+ GgtTiM(S_..NEC....s4N(.....'1ANJ5._........0.5_ _ 7-.if.Q.... <br /> r', <br /> .. .. ..._.. ._ _._ .._ _.... ..... .. ..................... <br /> ..... <br /> ... ............ <br /> .............. <br /> ...... <br /> ...... ................ <br /> _................ <br /> ........... ..... <br /> riNAL INSPECT. ' Q� Date_.. .5.-.�� <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1101 V Mardon A,.. 700 w.e 004 srrrri <br /> lza SYramsr.find 105 War v,h Sn.a <br /> fbdrM,,Callpreb tali,Celif.rnte M.M.re,Colilanie <br /> _ tmry.Catilernl. <br /> race <br />