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i s rOR CFI ICL U'E APPLICATION FOR SANITATION PERMIT Permit No 7..11 a.�..... - (Complete in Duplicate) Dote Issued Th,is Permit Expires 1 Year from Date Issued .�..:. Application is herebv made to the San Joaquin Local Health District for a permit io construct and install the work herein des:rtoeo. This e+ lcelion is made in :ompl;once with County Ordinance No. 549. JOB ADDRESS AND LO ATION..q .9' '._ e'::k<�. ..... ... .I.. ¢......�. l,Ly° �T .. Owner'. ;Jmre..... <.:........... .. �O ✓�iy .: c.. eTO.L; ._....... Address......1,Z...�9--._------ .._. .. ...111 .......... . ...............................................................�<. .............ry..... Contractor's Name... Y•!t ' . . ` ...................._._................. ...._................ ;nstallallon will serve: Residence ❑ Apartment House ❑ Cammarcial ❑ Trafilery�Coro ❑/ Motel ❑ Other �'k7/�.-a''t'`+ Numhar of livinn_ units: ......_ Number of bedrooms ........ Number of bathso�!:?'"lo: size ..l.la..Q...X...�.�L.S...................-- Water Supply: P,,blic system [3 Community system ❑ Private ❑ Depth to Water Table t ft. 1� Character of soil to a depth of 3 feet: Send C] vravel ❑ Sandy Loam E) Clay Lc am E] Clay❑ Adobe 1s Hardpan❑ _C Previous Application Made: (If yes,date .. ._. ._..._ ..) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No❑ Cr T TYPE OF INSTALLATION AND SPECIFICATIONS � Q (No septic tank or cesspool permitted public sewer is available within 200 feel) /r/n Septic To-,k Dis,anca from nearest wed SQ „.,Distarce,from foundptiol 'TO.. M,:ynel.p�u! ....... ... . " No. ' compartments d)-.......... ..Cize-Y/ .f .Jn.XLiquid depth. .. .. ..Cape:;`y..ldQO�'r/M1�. Disposal Field: Distance from r. arest wnG..ln✓ ._!);stance from foundation .ar15.......Distaice to nearest lot Namber of lines _. .. . .Length of each ne.sdr. .>3 -.Width of trench..._. Fype of filter material. A.0. :...Depth of filter material_-J� .Total length._............ .�e.f . ... e ..._Distance f am foundat on.. r r Q' Seepage Fit: Distance M nacres ell /D.O.. .�04. Dista ice to nearest lot Imo ...r' .. • FJ( Number of pits... c�..._._ .Li.un3 matarial../S'-0��t.. Size: Dlametc .3.3._.��9Depth. S_...... _ _.. Cesspool: Cistance fro•n rr+arest well. _ .. ..D;;Fmnre from foundation _. Ening materiel.... _............. ❑ Slee: Diameter........... _. . .... ..Dep h _._.__. ... ...._.. .._ . .Liquid Canaeity... ....... .gids. 4- PG;y; D;sfance rrom nearest well......._.___.. _. ._... .. .. .. _. Distance from neares' building...................... ❑ D;sic ice to nearest lot line_. . .__...._. . .. _. _.. ._._.__. ..___ _ ......_ _......... . .:.._._..._...._.._.. ..rt Remodeling and/or rope ring (dcscrbe) _. ....... .. .. .. ... ...._. ......... ..... ............... p1 I ..___._......................_. .................................. _.. .._....._.._...__........ ._. .. . ...... ..._........._. .......... . . .. ._._...... ........ ... .. . _. . _. ........ ._ . . ._.... _. __.... . ._)....... ... _ .......__. .__. I Is la tify that 1 have prepared this application and hay A pork will be done + accordance with San Joaquin Cou,& ordinances, , ems• laws, and Ie CQnd regulaiions of the San Joaquin Looc�al Health Distract C (Sig L �I . . ..77. ewN t�ry G{� �. _ _ ... ._. Iand/or .../,r Conrredorl Y Plot Inn, showing size oflot, Leation of system 1k relafion ells, bull _.. ---" (rite) ...d on Z11VI _.Owner and o ( P mgs, lr., can Lis placed on reverse side). ' --FUR DEPARTMENT USt OIJLY APPLICATION P.CCEPTED 31 .. . /( ?.:' - --.. .. . ... ....... DATE...... ��...... .. REVIEWEDBy... ......_.. . . ._. _. ._ .._ ........._..... DATE.... ... _.... . ...... ........... BUILDING PERMIT ISSUED.._..........._. .. _.. __ _.. . .... _... DATE.._ ...... ._...._. ..........._. Alteration!, and/o• recommendations . . . _ ,. ... . ......................... FINAL (INSPECTION V. _ . .. Dalc. _ . _ .... .............. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naullen Ave, 300 We+l Oat:Sae.l 'N Eymm ere Sneer 705 W.0 9n,Lrul Bradlee,Calile•nle Leaf.Ca11F.,nie Mame,. Ca llfe-,e Treq,Calilarnie h ____��,��swerele�aaler b`a�i�a. ��wLc�e�•pm'