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FOR OFFICE USE: ------------------ ----------- —.� —4 3 .3--3 APPLICATION FOR SANITATION PERMIT Permit No. ...��1..�_.7" -------------------- _.,- -.- ------ �s ------- ------------ (Complete in Duplicate) Date Issued _________________ This Permit Expires 1 Year from Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. .So.Lfoe/ 1A11V. .V7- 6e--_b/e E r5747-lw 4 JOB ADDRESS AND LOCATION. _ A0,Yr?_b.------ ----------------------•--------•--- --•----- •-------------------.--------.--- Owner's Name----E/1,111-PlY------..... i--------------------•--------•------------------------------------------ ----•-------------._. 4 Address----------C-�f .y1 C)----_---------------------------•-------•-•-•-- Contractor's Name 'r�' _1 _(_ 1_�S_� ------- _ O r ----------J-w-�-•------•--- ------------------- Phone-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other [�r Number of living units: ______ Number of bedrooms .-Number of baths ___2_1_ Lot size _____ _ -----------/ _____.____._ Water Supply: Public system ❑ Community system ❑ Private P- Depth to Water Table _,.!;� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date--------------------) No E? New Construction: Yes 5a,-NoE] FHA/VA: Yes E] No 2" F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ _'____Distance from foundation___-_ a_�___. Ma``te'rria _ ------------------------------------- No. ��' ' -- _- No. of compartments_._.__�=-------------- --�E._B'--_---Liquid depth__.-__-T.2.--------Capacity...4g__C2'2_-�__ Disposal Field: Distance from nearest well.._fr -' Distance from foundation__ _'______-Distance to nearest lot line___: -. Number of lines------------I----------------------Length of each line----------- Q_ ........Width of trench-------------- ` ._'-___._ Type of filter material_,2o_6_1 �-------Depth of filter material---_.__l ."_____.Total length_________________________ Seepage Pit: Distance to nearest ---------Distance from foundafion__r .........Distance to nearest lot Number of pits.__..____-__.__--_--Lining material.`_X _..Size: Diametpr�f__�__ _-Depti�______._.� ___�.. t , Cesspool: Distance.from nearest well-________________Distance from foundation--------------------Lining material------_-________._.._________________- [] Size: Diameter--.---------------- ---- -----_-.Depth------------- ------------------------- Liquid Capacity-- -------------------gals. Privy: Distance from nearest.well-------___________`.:_ _.___-_.__..__-------Distance from nearest building--------------------------------------------- ❑ Distance to nearest lot line.------- --------------------- ----------------------------------------------------- ------------------------------------ ------ ------ i Remodeling and/or repai'ring-(describe):-- - -- -- rSI -- ------------------- ----- 1-` 1 ------- ..M.�..w.�.- ! tom► = ------------------•----•----- ------•----------------------••---------------------•-- -------------=------- . ------------------------------------------------------------------------------------------------------- fa --------------- -------- --- jhereby certify that I have prepared this—application and that :.; -----------'---- --------- - - -- - -------- - =---------•-------------------- e the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulationsiof the San Joaquin Local Health District. _ rGw". '` -----------(.Owner and/or Contractor) (Signed)-•---------- . BY } # ��fr_syyRsf�_;em_in -= rt---= ----- --------(Title)--------- -E-->-------------- - - ---- ---- (Plot .(Plot plan, showing size of lot, locatilafion to wells, buildings,,etc., can be placed on reverse side). r II ' .FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = ` •�` •-------------------------•--------- --.DATE--- L__yJ f'� ---------------------------------- REVIEWEDBY ----------------------------------------------------------- DATE--_".,-- ------------------------------------------ 1. - 'ice-ems z✓✓ �_r Y- �_= '.�_ ,. .. ��--• —'.-,7-`---- C ( -------------------------- ---------- --- --- ------•---------- BUILDING PERMIT`1SSU�ED----- DATE------------------------- ---------_------------------- Alterations .. •-----•----- Alteratiansand/or recommendations.__ ___�_..__.- -. _ y ► C 3 /�- x/� E. ��l ?