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FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT Pamd1 Ne.elD9`�"�3 ................................... ............. )Complete In DuPBceb) .- .. Date Issued ............._.-.._.....................-........ ... This permit Expires 1 Year From Data Issued _ . .,,lr r,3 .;:•, a: Application is hereby mode to the San Joaquin Lae! Health DisTriet for a permit to construct acd install the work heroin described: This application is meds in compliance with County Ordinance No. 549. - / r .. �� JOB ADDRESS AND LOCATION-----.3-1... L..../. ErLl1Y .. .-......___........... S•r rJ G,f,'.�d/17............. ..�.../..... .. / Phe" Owner's Name'--.......-.!.. .-r.-.- er �_ __ ..'•;_•, 3 t .. Contractors Nam...-.-',� -.. .. ... .. ' .........._.. Phone. ; , ' . ' Installation will serve: Residence Apartment House Commercial C "t ❑^ Mo:tel ❑ Other ❑.. +` " X'• ' Number of living units:..,. Number of bedroo" .7 Number of baths-..,.:Lo}sM•.:. 0-__.._.-_._._.i r s S Wafer Supply: Public system ❑ Community system ❑ Privefeg Depth to Water Table—_it. } Character of sail to a depth of 3 feet: Sand❑ Gravel❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe Hardpan❑ ! Previous Application Made: yes, ........ _i No Construction: Yes ❑ Na ❑ FHA/VAl Yes❑ No❑',rN`vy;°;>j, + TYPE OF INSTALLATION AND SPECIFICATIONS: (Ne septic tank or cesspool permitted if public sewer is available within 200{oaf.) < Septic Tank: l Dstance from nearest wel..............._Distance from foundation..............._...Material........ .....--........... ...._..... :5. jjj'fi"f'•'. r{ ❑ j IVo. of compartments.....;._.................tSiae.............................Liquid depth..........................Cepacily..........::.� D Disposal Field:; Distance from noerost well,.d.LQ ....D;stenc�.from foundaflon......A9......Distance to nearest lot ..- j . .. line.. Numbef',Sf linos....:.... --. --- Length of each line...........;., ..........Widfh of french........ . _.i:.:.:.:. Type of{filter material of filter material ml..-../�r --. ..Total len94h..._....- P_'.�.... Scapaa0 Pit: Dlsfence io nearest well.. -lWO....Distancefr fou ation....AV.....Distance to nearest lot Number of pi1s......../........Lintng m f Diameter..... ---Depth......x �/..'.. - ttfr" ._. �� • r Cesspool: Distance from nearest well.................Distance from found,:tion...................Linina material............................ ....._A I} ❑ Sise: Diameter.... ...................__........Dep!h.t.......:.....................................Uqu;d Capacity........._......... Privy: � !Ilistence from nearest well.................-----------...................Distance from "erasT building...........__......... . 1 ❑ Distance to nearest lot line................. . ...-.......-.........__..............__---_......... ...::-'..-.::- Vemodel;ng and/or repairing (describe(:........ -2l•.•as l-LeSldiF:e'►-'Y rs ?F . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanees, State laws, and rules d regulaficed of fhp,,san Jo quin Local Health District. t (Si.lned)....... - (Orryr and/ar Contractor) .....:..........._.................-..... ( By:. .. _.............--..-..............-(Title)........ .. ... ...... ...-.-.. .:.............._... )Flet plan,spewing si: of.lot. f 'rien of system in relation}o welh, buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY.................. .r-.. . ..... .-..-........................... DATE.........Yr.. -- ...... fREVIEWED BY--............................. ..........................................................._........................ DATE........-...................................-._._...... i BUILDING PERMIT ISSUED.................................................._........_.................................... DATE..-.............-........................ _.._........._ i . �i 'AINr.Hions and/or recammendefians:.................................................................................................._............................--.---__.................. F t ......................................................................................................................................................._................................................._.......... - 1 ...................................................................... ................................................................._...............................................-....._.......... ......... ................................................................................................................................................. ............................................I............... .................................. ............................... ... ..:..................-................................._-.............................-...................................._...... FINAL INSPECTION BY:....../� �� re!t-. ...._. Date .. ��.F.�. ........... - s..-..... ... ................._......- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 leer iraurmn An. 000 W..r Oak Srna 124 Symm.r.Slr..l ma War 0e,%..1 H.dr.n,CalO.rnla L-H.WI F.rnia M."" ,Ceuf.,M. Treer.CelifoN. 1 r.r.co. � 1 I I Ski o0aoalJ l)