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FOR OFFICE USE: ._ ........................................... ._.... APPLICATION FOR SANITATION PERMIT Permit No. .a.,slg:.Zyk ................__..............--....... .. _. (Complate-in Duplicate) ,,�y: . .... This Permit Fxoiros 1 Year From Date issued �' I Q Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to cons}rvct and install the work herein descr4.ad. This application is made in compliancy with County Ordinance No. X$9. JOB ADDRESS AND LOCATION.,(/F/ ... •{oN.. ...... - :• fn %-............ Owner's Name........L.. .............. .... .. .E... .. .CC�{.... ................... ..... Phone.................................... Addross............ F-T..c�.... .5......._ .. ........G..f:!.:.:........._ ..... .....�� ............... ........."--- av .......... Contractor's Neme...... aF.'.... .... ... .rscf..... ......... .......... Phone................................... Installation will serve: Residence eApartmenf House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units. Number of bedrooms.yNumbnr of baths..!... Lot size ...R:�btat_29. ........................... I I Water Supply: Public system Community system ❑ Private En Depth to Watei Table ....... ft ri Character of sell to a depth of 3 feet- Sand❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay[Adobe❑ Hardpan❑ Previous Application Made: (If yes,date.. .... .. ...... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA:Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank er cesspool permitted if public sewer is available within 200 feet.! Se . ( enk: Distance from nearest well.—Ro.. _ Dis+arse from foundation.._ZA. �...Material -...................... No. of com artments....... depth.....4f .r.... ........Ce act} n..a ........ g, Di;posgf'Field: Distance from nearest well... °.._Distance from founJation..LO............Dstance to nearest lot IineS1........... r (lj' Number of lines.......... . UU v' /.......... Length of each line....I�(1.�.........Width oflranch.... c........................ Type of filter meferiol...... A..t._' _Depth of filter materiai.......;1. 4......Total length....-. A..P.................._......... See pey6 Pit: Distance to nearest well......./Op..._..Distance frop foundation...../..i7.........Distance to nearest lo} line.../........... t 7(1 Number of pds......Y..._..Lining material...... I.....Size: Diameter......3.1-`_._Depth......;&,A................. Cesspool: Distance from nearest well................Distance from foundation..................Lining material..................................... E ❑ Size: Diameter... .............. ................Depth.................................................L;quiu Capacity............................gals. Privy: Distance from nearest well............................... _... ..Distance from nearest.building........................................ ❑ Distance to nearest lot line................................................................. ......................................................................... Remodeling and/or repairing (describo):........... ................. 'Q.+f.. .....................,_._...... ...................................................... ..................................................._..................� .-:::.:........ �.< ...:a�>. �, ........... ................................................... ................. ................................................._......_...................................................................................................................... ............... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State la , nd rules and regulations of the San Joaquin Local Health District. (Signed).............. .......... .. ...__. ............................_........_........_................................__.._.�and/or Confractarl 8 :....._.. . ar. :.Q✓..a......... ,�(Q' ........... _........._._...Ti+le _..._......._. _..__........ (Plot p'.:_:, showing she of lot, Iota}ion o syzfemvir. relafion to walls, buildings, otc., can be placed un reverse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._. . . .. .Yl'J?�.lrf�.... .. ..................................... DATE. ./..`..L. .:.�0..7...r...................... REVIEWEDBY..... ........ _._ ._............................ DATE_.............................._........................ iBUILDING PERMIT ISSUED......................._.........__...__._........______............................... DATE................._.......................................... .i Alterations and/or recommendations:..... ____._....._.............._._............_._.......................