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tUROFFICE USE: I APPLICATION FOR SANITATION P►.MIT hermit No (Complete in Duplicate( i This Permit Exoires 1 Yaar From Date Issued Date Issued /! Application is hereby made to the San Joaquin Local Health District for a permit trr construct and install the work heroin described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS A D LOCATION.... 3 2 S '5 I EUI �f �c N PJ �p _ ..._.. _...... . . ............ .. _........... Owner's Name.... ame.,y, Q-----_Q _ l r .... _.... . rhons.T�.�i.'..S...L�Q a... Address. ......... I..I.S^ .. .S.. -. . Contractor's Name... ..... _.........._...... ........_................................. ..........._......_...........-�...... ._ .N.�... ............. Phone.............................. Installation will serve: Residence 9�KApertment House ❑ Commercial LayTrailer Court ��❑yy Motel 0 Other 0 Number cJ Public units: .. . . Number ty systemms0. Povate ;Depth to Water Table3..rc.. ft Cn [$..... --.•-.-.--.• Wafer Supply: Publicgystem ❑ Community o system 2., Numbe. of baths .Z. Lot size ..... .7�..... ..... V... Character of soil to a depth of 3 feet- Sand❑ C-ra..al n Sandy Loam❑ Clay Loam'Clay 0 Adobe 0 Hsrdpan 0 Previous Application h:ade. ;If yes,dote. I Nc e— New Construction: Yes El"roo ❑ FHA/VA: Yes❑ No B� TYPE OF INSTALLATION A!:9 SPECIFICATIONS: (No septic tank or;esspool permitted if public sewer is available within 200 feet.( t Septic Tank: 0i52anco from nearest ar.11. �•)G .Distnncq Irom Foundation. \jearial. ti V,e, Q� Ne. of compartments... .?� _Size...... QQ.G�d.�.....Liquid dpttthh-... (i.. AXL.. ;apecity_........._....G.... 1^ss Disposal Field: Distance from nearest well J 9 0 .Distance from foundation. 11,' '..!...Distance to nearest lot line., f 1-. tSlumber of lines..........I. OC' �< ?y•. - .....t_.-.��..Length of each line...._._/.. ,-. _r...Width of french......-.y.�.�!�s--.re_-� O - Type of filter material-...A V,.�6Lpth of filter mater',I �gt.wel�.Total len9'h_.J/Q,r...X-.1:................. 1( Seepage Pit: Distance to nearest well ?-Q0. -Distance from founriation.-1-9--------Distance to nearest/lot line.-jo....... 1 [J� Number of pits ..�- -. Lining material,.-NI.h� Size: Diameter.'...�. /Depth.f G ..a 14r/.roqrr Cesspool: Dist^ce from nearest well -. _Distance from foundation _._ . Lining material.�.........r. � ❑ Size: Diameter. . . . Depth _ Liquid Capacity. :_ ............gals. Privy: Distance from nearest weli .. . . Distance from nearest building..._ _._.. ............................. ❑ Distance to nearest lot line __._. . ........... _ ..............__..................._..... 0 Remodeling end/or repairing (d5:�ricc):. . . I hereby certify that i have prepared this application and that the work will be done in accordance will: San Joaquin County (� ordinances. Sfnfe laws, and rules and regulations of the San Joaquin Local Health District (S,gned).__ 0-1f-L1'.\ �,'...!`a�C-9-�_.. _ . . (Owner and/or Contractor) By:....._... ...................... .. ..... _. . .... .. .. . .. _(Title) eo-\sr�-�.\ .. (Plat plan, showing size of lot, location of system in relafien to wells, buildings, etc., can be placed on r--..rw ride). �— FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 � -� .... .. . _ .. DATE./�-2 6_? . REVIE"10 B!. _ .. DATE... ..... . .__._. . . .. BUILMAG PERMIT ISSUED._. .. .. _. DATE. . . .. . .... Alterations end/or recommendations: s. FINAL It.SPECTIC!J Bv: _ ..i,y Date i S ,JOAQUiN LOCAL HEALTH DISTRICT lial 1.Maranon a.a. 300 Wart Oak Srrarr 124'namma Srnor 203 Warr arh Se.r, sMAhrn,CHilarnia keai CalAarNa Manura,colilarnia Trci:allHrnla 17