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w FOR OFFICE USE: `1 APPLICATION FOR SANITATION PERMIT Permit No. ...� s!l. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued X/44.f.... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Couniy Ordinance No. 549, !OB ADDRESS AND Sll?E. . /V E..L .. ..../Nva......E._........�.T.eL�E.�(L.�,.... OwnersName................... ...........17�1.1. .�1 A.T.Er_... .... ........ ... ..... Phone................................... Address................... Contractor's Name......�i...41 VA4. Z'.......................... ............. Phone.................._............... ........................................................................ installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. / Number of bedrooms !.. Number of baths ..J... Lot size .....09.CR.E/4 6-r..•..•.............•.•... Water Supply: Pubb. system ❑ Community sysfom ❑ Private ❑ Depth to Water Table .70. t, Character of soil to a depth of 3 feet: Sand❑ Gravel❑ Sandy Loam❑ Clay Loam[Flay❑ Adobe❑ Hardpan❑ Previous Application Made: (if yes,dote ) No Ior New Construction: Yes ❑ No [&"_FHA/VA:Yes❑ No E31"' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted .f public sewer is available within 200 feet.) ` Sepf;c Tank: D;%Iance from ncare;i well.. Distance from founcia!ion. .......... ....Material _ ... .. ........... ........... PIC No. of comnartmanls Size.......... ..... _... .. ..Liq i;d depth. . . Capacity...... .. _.`:.. Dispos.cl Field: Distance from nearest weal �0 D;stance from ;oundnt; . on.... . U..... ..Distanca to nearest lot line...'i............ tr XE,FT't r46-- Number of lines -Length of each !:no... �`tz W;dth of trench ,. ?F^..../.......... t nA Type of f3ter material....j'GC.l�. .Depth of filter mate-ria' J..J. Total length _ _: 5.7......... Seepage: Pit: [);stance to nearest we!I Distance from foundation._...............Distance to nearest lot lino.... ❑ Number of pits Lining material. Dierneter Depth Ces.poo;: f);s,ance from rivares! well __ . Distance from foundoi .in Lining malar;al. 9 ! U5nmeter. Depth Liquid Capacity. gels. rtorn r.co•c' II Di '.. .ce from nearest bu;ld;nq Privy' nn I wr ❑. D;,!,-,ince to r.r_a---t i; _......_ 1 _.. ........ .... ...... p�.nro.,.:,,.q nn,^^,;i>r •..,. . .^.r. -... � �f�.f7 •V. /1�t .�..I�O � .'i ' v I heraby certify that I have prepared this application and that tho work will be done in accordance with San Joaquin County ord;nanccs"State laws, and rules and reouiatbns of the San Joaquin Local Health Distract. ' (Owner and/or Contractor) ($'goad) .��'<.. �ti.i<< 'i E'•,:f! :: ..0. 1 R, c'7 (Title) By:.. (Plot plan, showing s;zo of lot, location of system in relation to wells, buildings, etc., e.tn be placed on reverse side). FOR DEPARTMENT USE ONLY -_ DATE r> APPL!:_AT!`; DATE: F.EVi� '•'ED E'' DATE EU!LD'!]G PER,.,Il ;:;S'jLD Alterations andjor recommendat;ens: SAN JOAQUIH LOCAL HEALTH DISTRICT so;w ,• err,•.., ,7d s.• ,.,n,,.sr,r..r 70's Weft vra si—f 1601 E Korolron A— acs � Cuhl ro bro,nm >, Cu ....,a. rtn•.•,.rn.Co�.1o,n.c L•u c,ma i Srorl,+u..