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<br /> FOR OFFICE USE:
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<br /> APPLICATION FOR SANITATION46RMIT
<br /> ..............._.... ........
<br /> Permit No. �:�a
<br /> i.::.....:......r...................._._..... ......... (Completrin DupBcafe) Date Issued .' c,lL-
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<br /> ...:...._......... ..... ...__..._._._.......... ... This Permit Empires 7 Year From Dab Issued Date
<br /> Application is hereby made to fhe Sen Joaquin Local Health District for a permit to construct and install the work heroin deuribed.iZ
<br /> This application is made in compliances with County Ordinar, .s .. Sdo
<br /> JOB ADDRESS A LOCATION.-.74.7...._ !/ur'�/�J_ � .....Ilg.`. :----"•
<br /> Owner's Name.....L./�`.•.!� ±!^a..... JYLrGF/A<.?�:":...`.....�. ..... .......... ... .... ............ Phone..:(,!-� ..
<br /> 1 Address.-.._.....-..._.`sY!!k.?.T:-f..................._.. ....................................._..........-.. .-..._...............-..........-...:`.''.
<br /> Contractor's Name.......... ..._......_..........................y........... .-................................... Phone—.........................
<br /> Installation will serve: Residence A Apartment House Q Commercial ❑ Tralier Court ❑ Motel ❑ Other ❑
<br /> t Number of iiving units: .1..... Number of bedrooms..-?.. Number of baths.Q„ Lot size •„JlSj.,Q2q.Q..41...............I-.....
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<br /> Water Supply: Public system [3 Community system E] Private Depth to Water Table 16 ff
<br /> Character of soil to a depth of 3 fast- Sand Gravel❑ Sandy Loam❑ Clay Loam❑ Clay Q Adobe❑ Hardoen�
<br /> Frevious Application Made'. (if yes,date........... ...... ) No X,
<br /> New Consfruction: Yes ❑ No (� FHA/VA: Yes Q No
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)
<br /> Septi To stance from nearest well.................Distenie from foundation....................Ma erial... .. ..... .._.
<br /> o. of compartments. ....rn............Size..............................Liquid depth. .... .... .. Capac, 1
<br /> Disposal ieljt: Distance from nearest well...sem+//. Disfante from foundnrio ..../0 Distance to nearest lo♦;brte s„7. ..
<br /> ,�JS(s U umbrir of lines.........,L. .... .. Length of ac-.h ;no.....�'Q..! Width of french.. ..... ,a
<br /> r, of
<br /> filter matoriel ... QC Depth of flim material.../. ..r Tctnl lon li......... s I wn
<br /> .tl Q YP /�. . p Y-..... 7 �
<br /> Seeps a Pit Distance to nearest weJ .. ...._Distance from fouhletiod............ Dlsiance to newest lot line :.r
<br /> ') ❑ Number of pits,....... g q
<br /> _ ..Lining matoriel....... ..._ Size: Diameter ._.. .. ... Depth ._.-.. J.an`q
<br /> ' Cesspool: Distance from nearest well, .-. .......Distance from foundat on. .. .._.., .Lining material. . .... ).a
<br /> Q Sino: Diameter... ...... ... .... .......Depth .........._ ................ . . ........Liquid Capaclsy.. .._ .. •q"af a.N.
<br /> rnvy: Distancc from nearest well.......... .. ............ .... ..:..Disfancs from nearest bu:'dinq .... .. .. . '.p •w.
<br /> I] Distance to nearest lot line
<br /> A...._. . ./ ..... ..............—'—. .
<br /> ReL,p�dcr4lfZ sand/or
<br /> -repairing (describe):. i c :..... . ..........
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<br /> I hereby certify that I have prepared this application and that the work will be.Sone in accordance wit, San Joaquin Couelfy;,�.
<br /> ordinances, Slate laws, and rules and regulations of the San Joaquin Local Health Di:`dcf;
<br /> ISignod) ... _ ........ .... ..... ..... .. . .. ,. .. ... _... .. _... ner nd/nr tor)
<br /> 1 f6 a //�{y/ { Cont ac
<br /> [iy- Y'+• '7� '..G/L.6[.�G..�C .l�._!oYYG. .{.L�'[.C,,,l... ..._ .Tifio) ...__.. .._._.._. ..... ........ ` .:
<br /> (Piot plan,showing -..e of lot, location of system in relation to wells, buildings, eta, can be placed on reverse sido).
<br /> FO I DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY_. --CC-+L... ..SJ:G - .-- . . ... .. .' .. GATE......,'7-! ➢ n,;'
<br /> REVIEWED By............................. ......_......._........_.._............___........ ............................_..... DATE.........._........._..................._.........
<br /> .;:.;"
<br /> BUILDING PERMIT ISSUED_ ....��/ r ........... . ..y. DAT ,. .
<br /> " Alteratons anrt/yr res mmendetbons ...,lu':7'" . 7Th✓ :.I71c..ao asbrr. -S/Ie:t,.<nr�r.G,sG,r.. .asrL�u;
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<br /> FINAL INSPECTION BY:............. ............._ . . ................... Do+e ............-., .. . ..... .. . .
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
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