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FGR OFFICE USE. APPLICATION FORSANITATIONPERMIT ' Permit No. ...:./... ...� lr (Comple+.o in Duplicate) Date Issued This Permit_Expire% 1 Year From Date Issued /-e.::.rr�...... ( Application is hereby made to the San Joaquin Local Hee-Mh D;strict-for,3 per-nit to construct aid install the work herein described. This application is made in compliance with County Ord;nance No. 549. JOB ADDRESS�AN CATIO -...... f Owner's Name...... ctJ[-�/ /Rr� ..:.................... ...... ...... -. . ..-..... Ph one ...... i me--•--- = '�Q.._... fJ ...i,.`....... _ .. ttQ ........ ... ---'. ... ..... .._._........... . . Address.._ ... 17 ............ ._._.Phone.............. ..Contractor's Na '. '•...............-.....--.- Ins'allallon will serve: Residence LP�' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: I... Number of bedrooms _ Number of ber$s4eLot size ...��G+�'./1rta•r .....• s Water Supply: Public sysfern ❑ Community system ❑ Private �/bepth fie Water Tablet- ft. � 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam[� Clay Loam ❑ Clay❑ Adobe�ardpen❑ nsf /No ❑ FHA/VA:Yea .No❑ . �, r Previous Application Made: [if +es,date.- 1 No Now Coructicn: Yes �d x TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available with;n 200 feet.) //yyC �i /yam-:�....... Septic Tank: D;stanca from nearest well.-.,k... Dstanc� from founds on.. Mater 1 ��. L - 3 ..... a �.c...... ....L; uid de th...._. -- Capacity 1 d ` e No. of compartments--....2 S;ze-.--.'�.x.. 8 p. / r - Dispcsal FVd: Distance from nearest well '1= ....,.Distance from foundation is fie nearest let i dumber of lues..---"---"•.'2•. ..... ...Length of each I;nc ...1�"..y..rf-.... Width of trench....2.Y — Type of filter material.... Ps.-"-jZd'`Depth of f;l+er male: ......Total length..... ' #+ rL. Seepage Pit: Distance to nearest well...&..c -�-. . Distance 4t-,n f undafion...za.!......Distanco to nearest lot Ilne� i ®� ;:umber of pits.-p..2....... L;n1nc material..._ !.' ..- e: Diameter.�j . -......Depth 'y[ ' D;stance from nearest el! ....... .......Distance from found,)';on. Lining material. L ass oar: C p S;.c: D;er0er. .. .......... .. ........ .....Depth...........,.- Liquid opacity....:.... gals.," Privy: D:stacce m fronearest Wo11..... ar ...................... ....,..... .-- .D;'ane from neest building..._. ....--.... p ❑ Distance to "a- St lot I;ne ! Remodelizn and/c,r rera:,:ro (drscribO. 7*. ...... ......... .................. ............... F. ............. ..................... . ..... ....... ... .....................:................................------........................................................ ........................................ .. 1 her eby certify hat I have prepared this application and that the work will be done in accordance with Sen Joaqu'n County ordinances, Stat ws, end rules and regulations of the San Joaquin Local Health District. (Owner and/or on ac .(5' n Vr � .........�.tU-#. [`.xC.' . �. , -. ..... - ..,...- .....(rtle)...... ..��r 5 (Plot plan, showing size of lot, location of system in relation to wells. buildings, etc., ,.an be placed on reverse side) — FOR.DEPARTMENT USE ONLY APPLICATIOtJ ACCEPTED BY C_. .... DATE..... 4. /.�Y/etc' ........... - DATE.... ........... :... ................................. REVIEWED BY... BUILDING PERMIT ISSUED..... .. _-. DATE. ..... ....... . .. .... .. . ..... .................... t All e atla s and/or recommendations: . .. .....- ............................... i =:NAL !NSPr P0,': BY: SAN JOAQUIN LCCAL HEALTH DISTRICT 1601 E.Harollon Aro. 300 w•,'Oak st-1 124 Sy.aMaro Street 205 Wad 9rh Woof loth CnGlum;a Manteca,California TrocY,Calilcmic Sta<<ten.California . i - 77 111,