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s{1SE• <br /> r 1 APPLIC/,TIOPOR.SANITATION PERMIT <br /> (f,amPlet.in Duplicate) Oafs tsslsed <br /> > This permit Eroiros 1 Year From.Dab fsswd <br /> In bed <br /> .tion is hereby made to the Sen Joaquin L xaf Hea14h Distr ct fore permit to eanlrutt end instep Ohs <br /> oBcetion is made in compliance 1111 County.Ordinance N 549. I I <br /> � b�•R¢ <br /> DDRESS A ATI L Lltk' xf�rxsaa '" e <br /> s Neme.:.�.i!.!•�:�_•.V_ .Clls..!�r��:4:..._.... -. . ._._. .. -... ..... .._.. Phone is <br /> s....--..... ,................. -...................._..__........... <br /> I <br /> ph <br /> ..tion will serve: Residence Q Apartment House Q Commercial Q Trailer Court ❑ Motel ❑, OthetMJlCt71`".7rr,r.Y <br /> Number of living units: . . . Number of bedrooms..._.. Number of bafns ........ Lo} sfze ...._._...... <br /> ...-__._-...__..._.._-..._.._� - <br /> ycr of Depth to Water Tebta/., 'ft. <br /> Supply: Public system Q Community system ❑ Private y Loa Gay El �effi Hardpan❑ x A <br /> -4w of sail to • depth of 3 feet: tend❑ Gravel❑ Sandy Loam Q Clem Q <br /> sn Application Made: (if yes,dote......... ......... I NP [3 New Consfruction' Yes No[3 FFfA/VA,Yes❑ No Q <br /> � <br /> OF INSTALLATION AND SPECIFICATIONS: e <br /> lebls within 200 fief.) <br /> (No septic fano or cesspool permiffed if pubGe{ewer is evei <br /> : Taplr: Distance fromnearesi woll.�.....f...Distance�irom foundation.._........Met9riel,.Fi_�.. -:��••••••-•--•••-^ <br /> _ <br /> No, of compartments..".....-y....... ....Size,.S.. <br /> Liquid depth_y Z?:......_._Capacity..2,O.,om -.• r✓ <br /> nsal�eld: Distance from nearest well.,'!?.....,.D;staxe from ioundefion.... C..'XAQi}tante to nearest lot line_ .___ <br /> w y:..._..__... . <br /> Number of tires..... ... ...'y.....length of each Gn �r�A"Idth of tterK6•••-_•••''eZ.•� <br /> ��rs l,/�I• Total Lt,Ci_....._..:_. <br /> Type of flta• materiel..J.• �t•....•DOpth of flier material../k... ............. bnSt11---_!y <br /> ,eae t: Distance to refrestDistency.S/om f�ound�ze.:nD aer-."$Q Me to nearest lot rime�.. •••.� <br /> Number of p;'s .. .........Lining materral.``.ps�- <br /> pool: Distance lire^ nearest wall................Distance from <br /> foundation ...............Lining materiel.............................gals. <br /> ........-.. pac'fY......-..__.........._... <br /> � S::o: C;aq+e!e• .__. .. _.,....Depth......... . . . . . .. -Liqurd Ce L.. .-.................9....-. <br /> Dhten.o fro— ^eeresT well.......... .. . ..........._. . .. <br /> ..Distance front nearest building... ....... <br /> Distance to ^rO•es• lot line .. . .... ... - <br /> ............_-...........-..._.............._. <br /> iodating end/or rOpe:.rn (.:,,.r.ian):- ", ................._.........-.....................: <br /> ...................._ <br /> . ................................ <br /> . ........................... <br /> . ....--.._................................................. ...... ........... .......... <br /> ................ <br /> ..." . <br /> .... ...................... ..................... ....... ..... <br /> I hereb a ify the+ I hnvo erepQrnd item application and That tie work will be dons in aetordence with Sen Joaquin y <br /> :inences. #,a laws, d rules ndkegula" of the ;en Joeq:iin Local Health District. 1\, <br /> (I G:.! and/« Confracfor) IFs <br /> shed)"....-. ._t t - :.. ._ <br /> i r� Zc..�L< - hY . .(TiNe)..�.r•/I/ . <br /> By:........... .............. . y p <br /> it plan, showing sire of lOf. lOcn'Ian o�sysfem in "fallen, to wetter ildin tt-etc., un belated on reverse iate}—_--- <br /> FOR DEPARTMENT USE ONLY _ <br /> — r <br /> .... DATE . .".. . ... _.. .. . . . <br /> 'PLICATION ACCEPTED Bf rI r�' � .... DATE... ...:.. ................ <br /> -vIEWED BY. . DATE.. . . ... ........ .. . ... .. ........... .. <br /> ILDING PERMIT ISSUED <br /> •teretions and/or rocommrnda''^lis: <br /> r'rT Prtfr �Arr �fHc_rr 'r, , , r <br /> CCrti�<[ ' 7 SNti <br /> C-rHANSr- t�!tcr. 7G v,ET <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> M 4e:.r.ta,Y•.r• <br /> 100 Werr OaY..et.r <br /> tie Srtrae Sn«r 20S War 114 Sr.wl <br /> 1 JO Sau• Me•Y.a.C.Id.rnl� r+et r.CeNpnq <br /> C. .. <br /> l.ei.c.ule.•:. <br />