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FOR OFFICE USE: APPLICATION fOrIANITATION PERMIT P"lf NO. .,!f�1E.��' _.......... ._..... (Complete In Duplicate) - - - - This Permit Expires 1 Year From Date lewd Doh iwuad � �L t App,--tion it hereby made to the Sen Joaquin Local Health District for a permit to construes and In#%N the wark herein daatnbad. This application it made in compliance with Owrity Ordinance No. 519, JOB ADDRESS AhID 7.LOCATI N_...... .Lt ,e(�.�,�..�i,L.s...= � w _ Owner's Name QLKeL.., ►1 _._............................. ...................... ............_ .. ......_................__ _ ._.. vltoa.. Confreetor's Nema........ _.P_......._...._..........� ......................Q........................................ .................... Ir-`a0atioa w serve; Residen A erfinent House Cc+nmertial Tralltr Cew1 QMetal Other 13Number of living units: ../... Number of bedrooms �' .. Number of bsths4?.:jkot sin ......... .rt�t.. Water Supply: Public system ❑ Community .ysteln ❑ Private IR Depth toWater Table n5�.. 1t. Character of loll to a depth of 3 feet: Send❑ Gravel❑ Sandy Loam[3 Clay Loam(3 Clay Q pan E3Adobe Hard Previous AppliApplication Made: (if yes,date._....__........ ) No LW�,,/ New Construction: Yost No ❑ FHA/VAI Yea❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (Ne sepfic Tank or cesspool permitted if prlbBc sewer is available wHhin 200 fek:i I� i Septic Tank: Dl:fence from nearest weiLBQ.....Disten ) from foundejja.. r,:.)... Material. No. of compartments. '_ A/L_A..-LiquA dIgthi-X t- a..1C'laLprse`ci.t.y. /.-Aet.7.._.— __.1...............Sze..7 Disposal Field: Distance from nee well....0-0....Distance from foundation... ^ . D' f neo to noarest lot li • jpC( Number of lines... ._...... "" � ""...�/l�ength of each line.fio.•. .p'J�iIai-Y �of trench—Z,t��_......._ Type of filter mete eL.,,f72.4tA epth of filter material.../.). . . Tote; length........................ _._....._ Seepage Pit Distance to nearest well......................Distance from foundation..................Disten,: :: .lealetf bf line.............. / ❑ Number of pits.....................Lining material.......... ..... .. Sha: Diameter.-- . .. . _..Depth.............._............_. Cesspool: Distance from nearest well.................Distance from foundation .. .,..... .. Lining material..................._._.._....._ ❑ Size: Diameter.............. ......................De the.... ......... .. . , .Li uld Capacity........................_ ab. Privy: Distance from nearest well............. :...... ...... . _. Distance from rleer.sf building..................._......_............. ❑ Distance to nearest lot line......... ........... ... . . . ............................__..................................................... n 1� Remodeling end/or repairing (describe):_.:.. tl'.�.iL'yc.G_a._.`. �1........Lc.::..-5........ ..'i�......:I :r_` ...._-3_»- .--_�C•.� . ._....._._.._....--..._..................... J �r.:J..�..e'..R.-.. r' . . '�,¢¢ ! .. ........._ . ._----- ...............................................:......._.................... .... ..... ;ir- 3 ........ I hereby certify that I have prepared this application and the#the work w01 be dein. aecordance with San Joaquin County erdnanaa, State laws, and rules andregulationsof five San Joaquin Leal Health District. ............... (Owner and/or Contractor( By:...................................................... ........ ...... .......... ..... .....(Title)...................................... .. _. (Fat plan. skewing she of lot, location of system In "lesson to walk, buildings. sitar an be placed on mien-side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._._.. ........._ . . _.._._.... .. .. .._............... DATE................_..............._............. .__. REVIEWED BY............... ..... .... .. . DATE._ ... ._..._ _. �" Y BUILDING PERMIT ISSUED .. .7_.,,� ��.. DATE.....f.2...... ..^�......!a � Alterations and/er reeommendlefions .. .. _. . -....................................................... ..... .. .. ..........._................. . .. . ... ........ .. .. ... ....... . ...................................................... ._.............. ................. ........ ... .. ... .. ... . .. . . ......,I......I.... ................. ................I................. _.--..........._................ ._ . ._ .. .. . ... . . _ .............. .................. ............................... FINAL INSPECTION BY: De•e ......................... SAN JOAQUIN LOCAL HEALTH DISTRICT 170 Saab Aw«In.Lrw, loo w•.,Oak sore_, 124 S,.".1~ 205 Wo,91%rMN l,erkMn.hlllemb 1./I.C/IllernN Manb,a,Calll.mle Traer.GIILrnN SS 9 SC VI4�0 P-ne pu ry.ry' e'� ,