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f FOR OFFICE USE
<br /> lePs: ,,•, a.S < m Permit No. JW// /
<br /> �`5
<br /> AP"_ICATiON FOR SANITATION PERMIT Y p ..<
<br /> „ .... (Complete in DupRcafo) Data.Issued
<br /> , zv.
<br /> ......................A ... y me J o Tl` ir, Lm,r Health i Year Fromperms Issued ]
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<br /> Application is he eSy mer 19 5o.the Sen'Ic7qum L^//c"yq/a/,,l Health District fore erm�i}/to construct and install ffith�er workThis /(j11�'gp��
<br /> ication
<br /> ty
<br /> :(:e�<.)'.f c..:.. . \L'�i ,rf'� ,.. `'_y' dNfr fes/ ��Mr/% G'"'' i:+ L
<br /> �.,` 1 106 ADDRESS Is I -)CATION... CvrCnQ:rdmence No.,549 f/f •(.'... sI/ .. -Phone..:.:':... ......................
<br /> ' I #� Ov
<br /> -nor's Nemo i�P/� J /
<br /> i S Addross ._ ... ` /_ LJ.r 5... _................._.... _
<br /> L .y�.-.-
<br /> ,: Con#re..for's wame .. !.?J._.. .':2...u`c:............_ ............................. ......................_........_.......... Phone �t
<br /> InsteRation will s ..4Residence Apartment House ElL.ommeroiel ❑ Trailer Court ❑ Motet LlOther ❑ ,
<br /> s_,').... Number of Setfis l....... Lot size ... --. --
<br /> s Number of living unih:....f. Numwer of bsdroom - -••• ��-� -
<br /> t.; / ry
<br /> .I Water Supply: Por Le ,ten [' Community system ❑ Private: D pth to Water Table ....... R. -
<br /> tie 'k
<br /> Character of soil fo a de .n of a(+at Send['1 Gravel❑ Sand Loesn❑ Clay Loam❑ Cley❑ Adobe erclt�en[]
<br /> ❑ [L]. I A A,Yes IJo,,
<br /> ,11 Prravious Appli-atran 4!a(!+: (If ver,dote . . .. .... .) No Ne.w Construction: Yes No N G A
<br /> 's G TYPE OF INSTALLA.,CN AND SPrCIFICATIONS:
<br /> (No sept. tank_or c/gpocl permitted if public sewer a available within 400 feet.)
<br /> o, Sspt'c Tank: - r s+ance from nearest wed._..... .Distance from foundation............... Material. _ . . k di
<br /> , Nn. of compartments.................. Size .. :. ._Liquid depth .. Cope city
<br /> , . •y Disposal F" Id: Drstarce from nearest well..... Drs'ence from foundatio:ll&`._�.. Distance tc noarc sf of "no $ A�
<br /> jylumber of lines.................:......... .Length of each line..,/Aa / ..... .Widtrof trenrh -.7_4 rr <,
<br /> - Tyoe of filter material....Y.''I,vr..Xa.�=r6opth of filter materia /d-Y.-.1otal, Ieng+n .,/+92'1
<br /> . d �(
<br /> �Saepege. 'Art''' /�irDis+once to nearest well �JD / Distance from foundation /f1 f Distance to nsarest'lot L19
<br /> [ �)`'J ��Aumber of pits I. l.rning material..... '9Y}„� SI a Diameter ,3a ' .:
<br /> a l esf mo'1 Distance from foundation Lining materiel r
<br /> Cesssaao.. Distance from no.r Depth Liquid Capacity 79
<br /> r
<br /> Privy; DDi0a,,ce from istance to nearest nearest well Distance from.nearest bu Idmg S f
<br /> S��: Diameter
<br /> 4 .lot line .... ....
<br /> .. RemcxTeling.ono/or repairing (describe) . ....'- i/ ,------ ....::i ....................................... ar
<br /> ... _: .............................................. ... ...... . _ .. ..
<br /> ... . .... ..... .. . . .._. : ....... ..............................................
<br /> ¢. ...... . . .. ..... .. ... .. .. ... ......
<br /> I hrreby r rfy th..t I havo praparod this application and that the work will be done in accordance with Sen Joaquin County
<br /> ra ' ordinances, Sfota Irlwls,.end lilv!�,auj,r`ogulo-fions of the San Joaquin Local Health District
<br /> r
<br /> (argued) L7dr D '� J - _ - ....(Owner and/or Contractor) t
<br /> By .... _ ... .. /�r�f�.�/!nw'..�_/
<br /> (Plot Pian, showing e
<br /> sa .of l"at, lac.lion of system in rasafime to wells, buildings, etc., cos be placb on rrversa side).
<br /> x _--_ -- FOR DEPARTMENT USE ONLY
<br /> APPLICATION-ACCEPTED BY .(!'.G?�._ ...:...... ...... ......... ....... DATE......LG/
<br /> Rill BY ..:.':.. .......... .. . ...... . ....... .
<br /> ........ DATE. ........ . ..
<br /> BUI(.DINGPERMIT ISSUED.......... _ ..... ...... .. .._. . DATE. ...... ..... .i.'
<br /> A'tcratluns and/or rt omma�pfions _. _ ..
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<br /> P .... .ax�nUo .o. .... .
<br /> 4' .. .. ....... .................... .........
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<br /> k rINA� INSPECTIONb'Y...... ... ..T"��GO' --. ..... Dote. ......�1?.......r.+F......G,�............ ._
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<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 1"1 S.1hwe.n Ao. 300 w,ul rook S:rn.r 144 sr weer.Stn 205 W."91h Srwr
<br /> hLndi,Confernla Alum a,Ca:a.mh Trary,C9lifarnla y
<br /> - S1.Mr»,California
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<br /> r"3� ,a.k:Aefn�n61.9XG"6tllLit:"d�i.�t� ..
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