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FOR OFF CE USE: <br /> --------- .. ...... <br /> ---..........f1l.................................... APPLICATION` SANITATION PERMIT Permit No. ..Z: <br /> .............. ....................................... (Complete In Duplicate) <br /> ................................... .................. This Permit Ex Date Issued <br /> I iros I Year From Date Issued <br /> Application is hereby made to the San Joaquin al Health District for a permit to-constriid'ind 'install the work herein described. <br /> application is made in compliarl6s'p Pith County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIPN____$'0...X.... ..... .....---•............................................ <br /> __ <br /> Owner's Name__ !9�......V� <br /> 7 <br /> Address..... <br /> Contractor's Name.....AUA_�- 4 6_10-19C4------------------------------------------------------------- Phone..---------.._....—....— <br /> Installation will serve: Residence Apartment House 0 Commercial 0 Trailer Court 0 Motel 0 Other 0 <br /> Number of living units: j---. Number of bedrooms.3.. Number of the _4... Lot size ----t_4de_Ae_,. <br /> Water Supply: Public System 0 Community system [I Privet Number <br /> to Water Table VQ'ft. <br /> Character afsal toode'pthal'Ifeet: Sando Gravel [] Sandy Loam[] ClayLoom B—Clayo Adola.a❑[] Hardpan LNC <br /> Previous Application Mid*. (If yes,date............ <br /> 0 <br /> ....... I No W'O"New Construction: Ys1,e-<o b FHA/VA:Yes [I No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available Wilma 200 tea <br /> Septic Tank: Distance from nearest well.��. .......Distanc d <br /> .%from foundation.. .ion.. =M-eiflrial <br /> t ­ 2 - <br /> No. of compartments... ....A-Liqu depth-.-__ ......... -_ <br /> I id ---- ---Capacity....................... <br /> Disposali Field 4kbistance from nearest well..60.f Q.-.....Distance from foundation....IT.........Diltance to nearest lot <br /> Number l(if,lin'651........ •.....V!7=Le'K§th of from <br /> Iin&Zi35_�1.xiq;jjrild.W;dth of french-----aV r <br /> 1 111 I._ - ................... <br /> �,T);�e of filter m�'far­1iI'.AF:e0,rK_-Dso.th of filter material.... -----..Toial length.......16,�.W...................... <br /> Seepage Pit: Disfa'nce to nearest well... -Disfpnce from foundatio'n...4�_" .Diftance to nearest lot line_c. ..... <br /> Nu Aber of pits..!-------7__ 'Lining matehal-1K.R.0-4-K-Size: Diameter.....263.........Depth.' <br /> Cesspool: Distance from larest well from foundation....................LiAng material....I__............._......... <br /> ❑ Size: Diameter---t�A.... ......... ......... ..............­­.....Liquid Capacity...........................gals. <br /> Distance from naarest-well...!n.... building......... ............................. <br /> Privy: <br /> 0 Distance to neaTstilot line......_...--......--....... .....I..................air, `..........I.............---. <br /> Remodeling and/or repairing (describe):.......-_._.._.__..—.._.............. ...... ....................... i....____.-......_-..---. <br /> -------------------•-----------------'------------1 .................................... <br /> .......................................L­­.�.......W. ....... ....... <br /> .....�.%.........I ................ <br /> L ......... <br /> t .!.........__...... -------I-I......I­-— -- <br /> --------- <br /> ---------------------- 44 1 <br /> ............................I...................................................... ................ . ............................. <br /> I hereby certify that 1 have prepared this ItIpplic6tionsied that ihe'wori will be done in <br /> accordance wffh San Joaquin County <br /> ordinsinceSt state laws.,.and miss and raqui ftions of the San Joaquin Local Health_,pistriicf.�H •.....( <br /> % <br /> ...................... ...........10"er and/or Contractor) <br /> ... ................ <br /> BY (Title)...Ll........... <br /> ....................... .;em ... . .. ................ <br /> see, <br /> (Plof plan, showing iw'o fief, locallio ` "in ;ia4o, to Oells, buildings, etc-, can be plaU an revs side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED-BY --.79F------------------........._.....-.... <br /> REVIEWED BY.............f�---:.....::1:5 11 /...................................... DATE�...!...............j......L................... <br /> BUILDING PERMIT IS'4;Utb" 0 r / <br /> j...-- .........s..:........Z.:....... DATF-Al.........._7......I................... <br /> Alletrafions and/or reparn endptionu ........................... <br /> . ............=:..;...............2............ ...... --------A <br /> .4..a <br /> ................ <br /> ........... ...... <br /> ............................................... <br /> q <br /> FINALINSPECTION BY:__......_................................................ Date_............................................. .................----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soulb A~[Wrt Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Swition,CalftwMis L.dl.C.Iih,rilci Mcsrtt.ea C.11f...io Tracy,California <br /> SIP 9 49VINKIP B-51 IM 111-151 ATLAN <br />