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<br /> FOR OFFICE USE: !
<br /> APPLICATION FOR SANITATION PERMIT Permit No.,"../_..far
<br /> f _.. (Complete in Duprufal .
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<br /> I This Permit Exoires 1 Year From Date luuod Date Issusd
<br /> ,) Applieafion is hereby made to the Sen Joaquin Local Health Disfrict for a permit to amsfruef and indall the weir herein doic bed.
<br /> JOB HDlcation is made in compliance with County Ordinance No.
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<br /> DRESS LOC 710N... 'Gt,�j771y+.a,!✓L1Zfp ✓,nGfnfeat,.._Llars r.....'-�.^.. r
<br /> Owner's Nime : .lr ' ......,..T , _../_.. ............. .. . ... .....ecce Pnuns/�
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<br /> Addres�?.G%r.t� a(....1.-3 3.--�,. �1 �.r.�,�..--._ecce ............ ..........
<br /> Contractor's Name. �,2LLf�.[.. jt,�,.:.•S,g,eis1,vrC�� . `�q„�_...
<br /> ' .. installation will serve: Residence ❑ Aparfmdf Hnuse L_7J C"•nmorc;al LJJ -Trailer Court E] Mofel ❑ Ofher
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<br /> • Number of living units: ..!... Number of bedrooms Number of baths _� sixs ,/.���'..�.,h`...... ..
<br /> Water Supply: Public system ❑ Community system L—Y/Privatd•�.:)epth to for Table ....ecce ft.
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<br /> Character of soil to d dopfh of 3 feet: Sand❑ Gravel.❑ Sandy Loam lay Loam❑ Clay❑ Adobe❑ Hardpan C] e
<br /> Pravicus Application PAade: (If yes,dgte..........._.......1 No ❑ New Construction: Yes ❑ No FHA/VA: Yes❑ No ❑
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool Permitted if public sewer is availablo within 200 feet.
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<br /> Sep • D s+ance from ncwa t well......... Distance hom foundation......... ..Material.......... _ 1 `
<br /> r-rDlo. of comparfmpmt ...............Size......................... .....Liquid Japth ........... ...... Capacity ..�.^
<br /> { F sad Id 'Jistanco from nee,us+ we .a'�t./ ,.Uistence from foundation...✓.e.......Distance to nearest lot Iine .csd.•
<br /> Number of IinesL:>?t ....t ' A r
<br /> ��yyLsnafh of each linea.,!.,,,'.. ...........Width of irenr_h...c�. . 1.
<br /> _Type of filtor materiel. �3 ia.({.R'Dopth of filter metonal.. .�. . /r Total lengtfd,"S�.� ('#
<br /> S n ) Distance to nearest well (�j..r.7 Duten afrom ffoundation ) rDist�nffe to nearest lot Ime ��� ;t
<br /> r atm Numbor of pits...t. Lining material( ix„rL(......Size Diameter'. .. Tr. Depth_I'a./'tet Q
<br /> Cc ipSol:� r Distance from nearest well Di.tan:a trow4oundet:on. .. . -. i�g meta riel.,_.. .[!. '.
<br /> ssyy ❑. Size: Diansfor...... .. ............. Depth ... .....Liquid Capacity....... .... gals.
<br /> yqy Privy: Distance From nearest welt_... .. .. ................ . ...D stan;a Gum nearest building ..... . .. .. ......... . .
<br /> :Ls ❑' Uisfancu to noare<t lot Ilne.._.__............................._...._...................................._........................................_..........
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<br /> Re ones nq ane/o, nepe'rnq Idoxribnt) ... �^ . ................ ...... ...... ..
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<br /> I hc,aby e liy that I nave prepared+hi< applicafian and that the wo
<br /> jrk v ill be no in eceordanee with San Joaquin County
<br /> ord'nances, Spyes3y0;t Red rules dad regula on�f�fho San Jaaq/uin ti u/,Heelth is+ricf
<br /> (Sigm3dri../ r/�/.1 // f� (144OVins
<br /> -contractor]
<br /> By%- ............. . ....
<br /> (Plot plan: showing size of lot, location of system in relay to walk, W41dings, a, can be placed on revers side).
<br /> FOR DIPARTMENY USE ONLY
<br /> APPUCATlON ACCEPTED BY...uY:. -ecce.. DATE_L:.. •Z—�
<br /> . .. . _. . ........ . .. ecce . .
<br /> ,'. ReVlc VtD BY......... ................... _ DATE.........
<br /> 'I BUILDiNG PERMIT ISSUED...... . ..
<br /> yy wu4r4, ecce..
<br /> Alto,-e+;o n! and/or reeommendafions:e.A'/'� ..S 'TMS- C.CG7l .. .....3'� . .
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<br /> ' FINAL INSPECTION BY!:.?<. �• F.f... .- Date./: 6 7
<br /> SAN JOAQUIN LOCAL HEALrrii DIS"rRiCT
<br /> •H'' 1401 1,Xauaan A.. 300 W.0 O.k Slrooi 124 Sy<emaro Snwl 205 Wort 91h Srrooi
<br /> ,fir Aodfon,U114m1a !odi,Cali:emia Manmm,Ce Nlernia Tory.Gali'em�a
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