|
Seepage Pot
<br />Cetspotnl:
<br />0
<br />PrIvy:
<br />0
<br />Nstanca Irons nns.,. •
<br />tic!. of compsrtmn• '
<br />Distance fror.
<br />c-f
<br />tyro o f fil(r.r rP1(.••
<br />("Lifmnc e fo nelents m
<br />rJUmber of r00t
<br />D',1(eIncrt f,orn
<br />S;le: D;f1r110 (hr
<br />D;t(iinc oo f•orn
<br />D;0411,1C tO
<br />.1
<br />Materia'
<br />Distance to nemrest lot lin•tii"(
<br />Width of frencLt . .
<br />Total length :3'o
<br />7'OR diPARTMErsiTAISIONLY '
<br />7 ...- .7c-7.
<br />r
<br />1
<br />ISTRICT
<br />•
<br />,
<br />r,‘z
<br />Arr,r,c41;01 ,11 (.4,•i`y .,,*(f(tt • .r. •
<br />rpl:c81;efft I (.."1.40 •
<br />JOB ADDRESS AND.LCATION
<br />0_I...Name r
<br />Addrevi
<br />r TION FOR SANITATION PERMIT
<br />(Cempleto 10 DvpReelo)
<br />Downsit EjskLet I Vtai NT Date Issued
<br />. • I.aItts DIstrict for • prwrno r "4
<br />Y(i/Of/
<br />7 411'7' P! ,
<br />.•
<br />/e
<br />r.. •,
<br />Dn. n
<br />0•fl 'I ' ••••• desc4inn..1
<br />•
<br />• Non.
<br />" )1^ 11 Commercial . 0 Trm,!..• r„, our( 0 A.' ,Ial
<br />- Number of botirt Lot site . .
<br />rj Private cg Depth to Water Tab,* "
<br />s"*.haracter of San to a diapih of I fent: i Gravel 0 Sandy Loam 0 Clay 10,IM 0 Clay 0 Arfribl• E7.1 Hardpan 0
<br />Pre...us Application Modo: III vet l•ttn No rl New Construction: Yoss 11) No 0 FtLA VA Yes [3 No
<br />TYPt OF INSTALLATION AND SPECIFICATIONS:
<br />(No septic lank or cesspool perm;tt,•,f if public tower is avallabie within 200 Wt.)
<br />" Distance from foundation /4.. .
<br />Site .3 `t -.1..icto;(1.:InPlh
<br />D steince from foundation y e /.
<br />Length of each line . C
<br />ft, Depth of Filter material /'/'
<br />Distance fr.or foundation
<br />Dittance from
<br />Contra:1os s Name /. /
<br />Installation will servo: Rnsidrinc • •
<br />Numb*, of liming units: (1,
<br />Wow Supply: Public tystem • •
<br />( i nq Malarial /40 ( r- S;t41! Dielr,(4(ar
<br />Distance from foundation
<br />Depth
<br />Distancp to on,,,ost if Pin., act
<br />Depth /•
<br />Lining material
<br />Liquid Capacity . ..gals.
<br />nearest building
<br />oik.br 3 /Li,/ /oa t; 4.
<br />4 .
<br />s . .
<br />pmodolinq ew”e 1, or ,nro;,,,,o (dr te !
<br />........
<br />7:51.1 11( 4
<br />I Isorolty certify that I Nave preparn,i (l4:4 rpliCa(;0.4 and that the work will be done in acpordenco with San JosiguirtiCostrity
<br />ordinances, State laws. end rules and ri•niulatIons of the San Joaquin Local Health District. 111.
<br />I:
<br />.
<br />(Owner and/or, Corsfractor)
<br />I I
<br />(Signed)
<br />Byt.
<br />(Plot plan. showing s. of lot. location Of
<br />r - .) H .t;f7:.',.. -'4.• •
<br />!..... • 1.„ , ..,A, . . (MIAs) .;:t ....: • ,
<br />svsInm in relation to w ens; ,baiklktgs, etc., Carl 1"4 plaead on revers.. side). , 7 t;,,.• t..sk..
<br />7'
<br />APPLICATION ACCF:PTED
<br />
<br />REVIEWED .
<br />BUILDING PERMIT ISSUED 41
<br />Alloratirms and/o• rocerrimonefOlL
<br />%)11
<br />rirJAL INSrECTIOr I 0 ,
<br />(1 I ,/,
<br />I )0 1•1.,4. 1114440.1••.,
<br />1,•41,•••• C•' 4.• • n
<br />. , •• .•er. • ,••• • • • •., '
|