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kk APPLICATION POR SANITATION': PERMIT Permit No. (Complete in•1?uplick#e} Date is Date f Application is here made to the San Jo l i the" x cx�b This application is'made in compliance wi#h-County 4rcCinanoe l�lo. 549, pp Joaquin Local Health Dlstr,ict for a permit to:construct and install JOB ADDRESSAND'LOCATION__:._.- . "o._ 40-tA _-AdAd_1jC l $ y Owner's Name-----��.-- -j-- .r Address r , Contractor's Name- e._. .i.------ - ,t�Rll .._v '__-- �-_ Phone f •- _. Installation will serve: Residence Apartment House Commercial � � P �] Trailer Court ❑ . 0 O ❑ Number,of living units:.drfM_ Number.of bedrooms Number of baths Loisize ___ j> ______________ Water;Supply: Public system IX Community system ❑' Private ❑ Depth do W;dter `able _ .._ ft '^ Character of soil to a depth at 3 fee#: Sand ❑ Gravel-M SandyLoam❑ Clay.Loam ] C1ey.❑ e Har n Previous Application Ivlaile: Yes ❑ No [ ,New Construction: Yes [Q' No R TYPE OF INSTALLATION AND SPECIFICATIONS - (No septic tank or cesspool permitted if publicsewerI's availabie�- :• 'fee#) ' Yn, K Septic Tank: Distance from nearest well............ .__.Distance from#gundation __________________Material. -; ❑ Ncs. of compartments____: Size........... ........Liquid depth - ..._cap 18, - ` i t Disposal Field: Distance from nearest well.--------------_Distance,`from foundation _...Distance to`nearest „.- ❑ Nurnber of }fines-. --------------- ------- ----------------Length.of eachaitre ._..........................Width of trench r Type of fitter materiah._ ______________Depth of.filter material.-_------------jetal length------------- Seepage _____. -.Seepage Pit: Distance.to nearest well. -�— _______ Distance.from foundation._ � ce to nearest lot n Number`d# pits.: '1!�__-_-_Lim g material__, P,4ax._Sizew Diameter-_ ��-. x Cesspool Distance from nearest well----------------Distance from foundation_ ._,,------------Lin in _ al_: _-_-_-•w = -- ----- Size- Diameter-.-_. . ❑ __-•-- ._ Depth LiquidC c apa city. . Privy: Distance from nearest well 9 DIs , fd1n ❑ tot iatte-.__. -- -- Distance to nearest _-,.- Remodelrlig and/or repairing (describe) ..-_.-_ _----_--_ ,,.. _.w__._. ._,.___- �.� „ 1 hereby, certify that l,have prepared this application and that the work will be,40, withSa ordiaancesti S laws, and rule$.an #icy of��he San j ;gain Local Health I sti r `' .v (Sr9nsd�- 'w --!__- -_- .i 0� - 1 + !" / Ow /o BY - (Title) } - - r , (l'!vt , sks r#nCg si e.of lot, location,of system in rely on wells, byildiegs, etc., can be plaoit averse sided _ = _ k , FO R DEPARTMENT USE ONLY APPLICATION ACCEPTED B __ - DATE.. _ . i REVIEWED BY- -- DATE; ` t --, r - 4 BUILDING PERMIT"ISSUED-__-- �._. --- ---,__•-- DATE _,-- Alterations and/or recommensla'honsi-- ----.............. __..:`• ,,. ------- ------------------------------------------------..........,.. ----- ------.. ._-___._ __- ________ _ ___---------------------- . �. _, ..s. ------•-- _ ----------------------- .. ...w.... ________ __________ ____�._�_ <: ....... _.....___ -i........._............................_,._. ._-aw:��.. _______________ ________ .a_---__ .-_._--__ ...__-..- .._._.___--------............. _--.u.,;i ♦.___.. ._._..» ......-..______.•. T Mr. BY:. _ Date ------- FINAL'; INSPECTION _ SAN JOAQUIN;LOCAL HEALTH bISTRICT` .130 South American Street 3,90 West Oak Streeti32 Sycsinore Strsef 814 North "C":Street 5tookfon;"California 1 ,California M�nteaa,:Ga(ifornie Tracy, California ES-9-2M 8-51 Revised W-2100 r -.,a .-• � _ -