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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT Permit No. (Complete in DupRcab) Dab Issued /c'l�f-6 16— _ _. ._ . ._ This Permit Expires I Year From pate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein daeelbed. This application is made in compliance with County Ordinenncc /No. S JOB ADDRESS A D OCATION...... Q....�.. ....d.... ( .;4�r "--••- - �J Owner's Name..... ..... 4......... ........................................._...._..... Address......................... .. y ............._..................._ Contractors Name..... lrf/.,�/�r—RQ/!J.r.....A°... ................................ .. ..........._. •Plrort _./_�r. . Installation will some: Residence � Apartment House [3 Commercial [3 Trailer Court [3Motel ❑ Other ❑ Number of living units: .... Number of bedrooms ac.. Number baths ../. Lot size ...1-4t e? ----- Water Supply: Public system ❑ Community system ❑ Private [>� Depth to Water Tabla*y ft- 0 Character of soil io a depth of 3 feet: Send C] Gravel C] Sandy Loam❑ Clay Loom[3 Clay[3 Adobe g .H�rar'cben E3Previous Application Made: (if yes,date.___. _. ..I No D New Construction: Yes ❑ No �FHA/V,0u Yes 1.t _ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �. f ark Distance from nearest well........ . ....Distance from foundation...................Material.............. .._. No. of compartments............. .. __---Size.................................Liquid dep h..........................Cepacitif a e F d: Distance from nearest well.................Distance from foundation.. . »....._...Distarlcs to nearest lot Number of lines.......................... ........Length of each line........................_...Width of french-..__ 49 ' -...• Type of filter material.........................Depth of filter materiel.. .................Total lerko _......._...i_.._.._.......... Seepage ' : Distance to nearest syell.1IC.0.........Distenc m f ndef ,$ ion.. ..�._Distance to nearest,bMline Number of pits......//............ meferiel/ .. Size: Diameter...f/.�'..........Depth__�.S'L� Cesspool: Distance from nearest well.................Distance from foundation..................lining materiel ❑ Size: Diameter......................................Depth.................................................Liquid Privy: Distance from nearest well...................................... . . .....Distance from nearest building.:........................_.._.._. ❑ Distance to nearest lot line................................. .. ... _ _........................_..._......._............_....................... _ _.. Remodeling end/or repairing (describe):...( _. ..� ...............................�......._...................................................._........_..._......_..........................._.............._.......».............................. ......... I heroIs cern that 1 hav replayed this application and that the work will be done in accordance with San Joaquin Cao* ordinances, fete laws, and• Ise nd regulations olf thehSS J-oa�quiJn Lo`calt alltth'District. (Signed)....... .,�.,. ..r.G1...C ._.ST Pas"`^✓ ..... �!! .•.. ......... .....( ar arrd/er Cartreeler) .. s a By:..........__................... Q . Ls~ .. tle.......... (Plot plan, showing size of le , Iocetiaa of system inroldien t alb, buidings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY................... ..................-................ . DATE...._./O..c..i.ri.".-..(.n.. ••.............. REVIEWEDBY...........................__............:.... ............. .... .._ _._....,................................ DATE....................................................... BUILDINGPERMIT ISSUED..........................�..�J. ............. .............-...................................... DATE......._.....»................................ Alterations and/or reeemmendatiems.......f.'..6�5.'..Jw.r,rs.rJ.... L: ..,:.. :GC.iri..N ....--CtC....de•,.,t•.a..... ....... a../ .L,_.. ....................................................... ........................ .................... ... .......... ........_..................................................._. . .. ............. .. ._ _ - ___..................... ............................... .................... ......... .__........................... ..........._......I... .. ..I., .............. _ _ _ ..................................................... ............... ......... ............ _ .. .............................I....................... FINAL INSPECTION BY:....c:Ni�..7-...L_ ..:: ......... . Date . ....E.:,? ...................I.......... SAN JOAQUIN LOCAL HEALTH D;jTRiCT 130 South Amedran Stleat 000 W"I Oak Snot 124 Syramery Sbaat 203 Watt ath Ayer fta<41an,Calllsmla fNl,Calllernla Mantam,Callferela Tycy,Callfemle o n atvmv •-av aw a-u •µ•e -