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FOR OFFICE USE <br /> APFLICATION FOR SANITATION PERMIT permit No. `. <br /> (Complete in Dupl'icnte( Date Issued 3__x_41 <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a Permit to construct end install the work Herein dexnbed. <br /> This application is made in compliance with County Ordinance No. 549. - <br /> ' O . .y .... . �'• ... r <br /> JOB ADDRESS A . <br /> Owner's Name. ph-one.._-------_�.- <br /> _..._.._..._ <br /> Address_.__.... .. ✓. .. - -...... ._...__ <br /> Contractor's Neme. .. . LLr-1y.[�r��./ !mfr/. !�! ._... .. <br /> Instalishen will serve: Residence Apart;.." House C..mmercial ❑ Trailer Gort Motel ❑ Other [3 <br /> Number of living units: Number of beor-ours. /. Number of baths ..1. Lot size -. ..5 Q'�= ------—------— <br /> Water Supply: Public system Q C• -1 Private[}Depth to Vater Table {t. <br /> Character of sol to a depth of Sandy Loam❑ Clay Loam Q Clay❑ AA0bee0' lHardPan❑ <br /> previous Application Made: (it t New Construction: Yes a�No ❑ FHA/VA:Yes❑ No❑ <br /> TYPE OF INSTALLATION AND <br /> (No septic lank or cesspoa pr. . ,.avdlabla within 200 feet.( <br /> - . <br /> Septic Tenk: Distance L.-, nearest ::.tette from foundation.. . ..�_ Meterie:. .�' - l ��jj <br /> Ido. of compartments. SIC <br /> size.3XSX% ---....L-iquid depth..r% r .. Capacity..Y. 74... /-Ilk <br /> L <br /> Disposal_F.e!d: Distance from searest well 67.' y Distance from foundation../..G- ---. -Distance to nearest lot Gny_._.. S.- <br /> (� Number of lines ... .. Length of each line_ . %!. VAdth of trench. <br /> Type of f:;ter meferiel5• .Depth of {71fer mefedal. Total length._..... <br /> .. �-�------- <br /> * ...L.......Distance to nearest lot line.-_S_.__. <br /> See[6Pit: Distance to nearest well/LC. materials be r- S;.e: 33 Depth .�5.�............_. <br /> J� Number of pits r Gninq material./�O�h' Sire: Diameter <br /> Cesspool: <br /> Distance from nerrosi well Distance from found&#-- Lining material. ........................... <br /> - <br /> Cl size: Diameter Dep 1', Liquid Capacity. ................._....g0Is. <br /> Privy: Didonce from nee•oz} wEil <br /> D::-•:^<s from nearest bu'Idiog ..._.__...._.._.. <br /> Distance to eCarOet lot lin? <br /> Remodeling and/or tepa:r:no (dcscribal: ___111_` 'd•� + <br /> I here certify that I have prepared this application and that the work wi8 be done 'n accordance with Sen Joaquin County <br /> ordinances, 5t.s.laws, and ru4s and rog tions of the San quin Local Health District. <br /> LjiVf- T / <br /> mer and/or Contractor'. <br /> (plot plan.sheeting site of lot,location of syste m Talar on to wells, be s, etc, can be ced on reverse side} <br /> V/7, <br /> DEPARTMENT USE ONLYDATE <br /> _♦PPLICATICN ACCEPTED B DATE - . .REVIEWED BY !- ! DATE <br /> BUILDING PERmIT ISSUED <br /> Alterations and/or ... __........................ <br /> jr .-.rte r T <br /> tl p <br /> Is�q <br /> FINAL 1N'PECTICt. 31.. <br /> ` rSAN JOAQiJtrd LOCAL HEALTH L-ISTRICT <br /> IMI e.tna59een A.. 500 w. 015$•..N r l'a 1..0.x...Hml 5a 5 w..1 91.SI.—. <br /> lM. ca+IMn1 MOn..tO.E. r..n,a I.Oa r. E01.10.ni0 <br /> ara+K Ge:r+r++ <br />