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FPR OFFICE USE - 1 •, ~ .lA. �.b.Y .. ...(�r. ... ..L..11�.•.4!.f rt 7��L/6�/• , . ... ,,, APPLICATION FOR SANITATION PERMIT Permit No. a, A r ......... .._..... (Ce ,,a In Duplice+ol Date Issued./ <..•S� k� ............ This Permit Exoiros 1 Year From Date Issued ....... Application is hereby made to the Lan Joaquin Local Health District for o permit to constru t and install the work here Eau rbed�p II {vl t_E AO•e-T IK v a u }j .h' This application is made in complidnce�with-Coon 'Ordinance No. 549. I t✓fr... ... JOB ADDRESS AND LOCATION.. �• a / .. ...:: Phone.'�.Fl= Owner's Name....:.Y1C(5.13.w- ..f .l.)......G.l.` .................................................. ..................T. I Address __.�[T "m..jrr..,.t.......................................................................................... ... . ..... ... ... `{'!S.r y . ...... Phone ..�? T .6o v .................................. 7 Contractors bnme � '..71Z.�*.-1-`s-�;�...-.-LN.�r. !! e�]aK r+ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ ?railer Court ❑ Motel ❑ Othir e ra ti f b..:.G# sr P s.. . ..... . Y Number of living units: ........ Number of bedrooms....... Number of 'oaths ....... Lo terse Dept to 'JJefer table .. ft s}' Water,Supply: Public system ❑ Community system ❑ Private [) p Adobe Fii3rdpen�q Character of soil to a depth of 3 fleet: Sand ❑ Gravel❑ Sandy Loam❑ Clay Loamy�❑ Clay o f , o Previous Application Made: Ilf yes,date ... .. No [�'„ New Construction: Yes U No FHA/VA: i s❑ No TYPE OF INSTALLATION AND SPECIFICATIONS 4 ? (No septic lank or cesspool permitted 6f public sewer is evmlable wijfiin 200 fec#.) Septic Tank: Distance t'om nearest well - 'Distance f om foundatias........... i Material....- -tea act -- . 0 � 2 No, of ccmpurtments Size..... ........Liquid depffh P Distance to nearest ldt ;qe ..... ' D saosal Fie width Distance ;,cm nearest well ! Distance from foundetion....-...�'-F of trench lk Type of filter maranol.....:. Distance fromhfoundailon......1.Q kQg4 9.iL9afesL)ct Lne,..�.�. Number of boos g \s materia n�4 P p f26 e Seepage Pit: Dmenca To nearest well )oQ. DepthXof filter foundation -. 9'lengthfi �-;,a, Number of pits...._ 7> ..Lining materlaLS �la.CIS..Size Diameter �}0 .'_ De th. t. . - .Linin material , -' Cesspccl: Distance from nearestwell....... ......Dlstancefrorr/ .Liquid Capacity._.... ;. r] Size: Diameter....... _ .... Depth. . __..... - - C . - nearest building •.,:„ ,, Distance from n i. Distance from nearest well r - - ? Distance to nearest lot Ilna y ... + - ' -" 1 u ( bll '!"P e XLS�1.ti ry 4Sr WI a a, Remcdeling and/or repel ring dascri of. i .. „_ a, ! p . - .. . -F "` ;fy Q tend that the wort'w'Q bs done m accordance with Sen Joaquin Gaoniy 9 x� pn Joaquin Local Henl+h District. I herebyy csrfi that I have prepa;ed this epphcati(in ordinances, Stato laws, and rules and me ulatlont of th S rtra t _ r r •A"il - _ _ ... .. (Oyina and/or o i (Signed). 9 r __. rC11/�`— r o C i e sj BY: cr �— (Title) id . r � NCC RR — wens buildings etc., can be placed on,reverse side). 4` / i Plo+ len,.showm sae,of tot I?ea ion 61 system 1FOR relation 4 .' (— P P .RTM�N T USE ONLY I DATE . ... APPLICATION ACCEPTED BY .. .. yi ~'-. DATE �. REVIEWED. B ... . ..... _.. ' T - JJ if BUILDING P°RMIT ISSUED ; 7;., ,r. ? f FJteretion end�'or recomme nd. _.- SSSSSS - _ .. 1/ DATE I.' . y .. f'.,� .. �a�.s. Y .... .......................................................m ry. _ �' i rJ` .... .. .. ... S .. i. .._ ' .-- j, Deto..... ... s� �. ... ..... e ................ ....... � { /U� . . - - • FIIJAL INSPECTION BY .�1L�...... SAN JOAQ UIN LOCAL HEALTH MSTRICT I s. 1,05 Wnt vih Sheer 1601 E.Xmepen Ave. 300 WW OoY.1. 12n SYmrnsn Armor 1 1 loll.Calllernla Honrero,Cvllforniv T'err.Calife.Nv S . Smrsun,Coefsrnle •;�' [[ v nSviv[O B�9e ]M Y49 LPCa. ,'t.