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- FOR OFFICE USE: I _ J APPLICATIC!V FOR SANITATION PERMIT Pare@ No. .�.Q•(;�D I 'i !C3mPlefe in Duplicate) - is Rcrmit Eaoiros 1 Year From Date Iswed - Cafe Application is hereby made to the San Joaquin-Lecal Ffanlfh Uisfri<t for aparmif to construct en �e��. This application is modem compGen with County Ordinance No. 549. alwute(f the work herein d rail=LQ_ Ai _OB ADDRESS AND LOryAT ' J s.._._JSnr�.� i�D..,,lo.... ,.__So.......F.RnI ...�mt�...._hb......._... ".i O«ayr's Nema.._......... 1G.... .{ZGA�l...._ .. ....... ...... " .. ... .... .. L.Phone.......... Address....__._... —_:._._... Contractor's Name.......,pWNER_.............. ; + .. l iPhone..._...._._....._._....._. InsteBNion wig serve: Residence Q';lparfinent House ❑ Commercial [3Trailer Court ❑ Mo�al ❑ Other ❑ Number of living un;N: Court of bedrooms. ... Number of baths .. .... Lot size I RE / ..................... Walter Supply: Public systom 0 Commenity system ❑ Private JR-,Depth to Water Table i S{t Character of sol to a depth of 3 feet:, Meed(Gravel Sand Loam y ❑ y r «_ ❑ Y ❑ ..0a Loam. Cla �b Adobe❑ Hardpan❑ Previous Appliufion Made: of yes.date .j.._... . I No 2r New Cons}rvc}ion: `fes� 1 FHA/VA!Yes 13, No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {# < INo septierfaslk or cosspool permitted if pubSc sewer is available within 200 feet.) s' Sect' Tnk: Distance from nearest well._JS. ...,_Distancp from foundation../D..... ....Matere 4-sEZ>W.e(�.... ._....,,....,_ -- �� No. of compartments... 2. ..... Si:e.. ...d� .Y.�r..._Liquid depth...' �d.;...._ Capacity... Disposal P,ald^ Disfance'from nearest well 50.... D;stance Gom.foundatlon---.. .. /�..........Diztenc 4 reeresf lot ja— Number of lines_._............ . .......Length of each ;ne.eb.-..75.7,7},.Widfh ffench....2 �_ Type of filter mate•iel.../�7C/t�... ..Depfh of filter mate7re,I.`.�.y4........._._Totel I��th........... Seepage Pit: D;sfance to nearest well ... Distance from foundbliern.:............_.DntandCftC nearest lot line _.._ V ' ❑ Number of pits.... ..._. lining material....._.._ . ...Size: Diectefer...............<-:i Depth......_........ Cesspool; Distance from nearest well .... Distance from foundation i. ..._Eningterial............_:..:_......._..... ❑ S;ze: C;amater.... ... .. .. . .. 'Depth...... fi .....Liquid Gppaei i ..._ .. ) ty._......___._'---...gels. i Privy: D;sfonce from nearest well. ......._ _... . Dis:•a:., trans nearest building.............................. ❑ Msfance to nearest :nf itn l;C. _ ........._.........._�._......_..._....{�.. _..... .................._....................._. Remodeling and/or repa;rina Idcscriyj;.�Tfsiyr. LJAIm__.NAT.....ICY"�P..........TrfSxQ.i ............................... ................. _...................................__.......... ._ ..__...... ------- .a.>�........_......................_._..._................ ......................... .................................................. y...:.,...!. ................................._..L'......_... .. .................. ... Y .Y............. . P../�''.'.`'".�/... ... __.._.._ . __,......__......... .. ._ ._ ..._ h Sen Joaquin County I hereby earth{ }Ilei I here prepared this application and that the work will be done in accordance w' ordin6nees. State I w•, and rules end re Matrons of the San Joaquin L Health District. (Signed)............ i. (Owner and/or Contractor) By:....1....... _.............................................. ._....._... _. .................._... .._......... .....(T'ifie)....... . ............ ._ __...... .. _... _.._. (PX3f plan. sh S size of lot, location of system in relation to wells, buildings, etc., can be placed rzn reverse side). FOR DEPARTMENT USE ONLY APPLICATICN ACCEPTED BY. . 7--;R.0 . . ..... _. ... . .. DATE.. �."..�... .-6�i....:........_........ REVIEWED BY_ .. ....... _..._ _.. _. _ _. _. .......... ..... DATE. .. .............. BUILDING PERMIT ISSUED_.................._.. ...//....... .. ......_........_......... ._............ . DATE.... ................... ............. Alferetions end/ar recommendaf?ons: / -e A6- <WMEC779 L5 ...N6C...... ._........ 0:/.4._. ....r.{?..Q.... .... .................. ......_ . ._. . .. . .. .. .. _.......__....... _........................_............................................................ ._...... .... .... .... .... _._.. . .. _. ._. . . .__.. ...._. .. _. .. ...... ..................._... ._........__..._.... . ._.... _....... ........ . ..... .._._ . . _ .. .. . _ .. __. _ _. .. . ..... .. . .. rINAL INSPECT. v� 1r•0 Date _ S , 6ti SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.H.Wftn A... 300 Wnr,Oak Srg91 114 Sycame,.Sir.., 303 Wo,91h bru, bedb,r,,Ce111.1.9 Ledi.C.10.,nw Monn<9,nolif9m{a troy.C04fornia ..r.a