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FOR 161' FICE USE- ........ APPLICATION FOR SANITATION PERMPermit No. IT ...... ............ ...... (Complete in Duplicate) Date Issued .�IaAel This Permit Expires 1 Year From Date Issued A,pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install thi work herein described. This application is made in compliance w5th County Ordinance No. 649. -7 2.5'10--YC c 6 A) JOB ADDRESS AND LOCATION-,< Nam X�, . Phone ... .... .. Owner's N -1. Add, .... . ........ 'v .. . ...... . ........ . . . . Contractor's Aqze�............................ Phone ............... Commercial [] Trailer Court 0 Installation will serve: Residence Apartment House r7l motel 1:1 Other 13 Number of living units. Number of bedrooms ...Number baths --- Lot size . ..... D Wafer Supply, Public systim.Cl Community system 0 . Private Depth to Water Table Character of soil to a depth of 3 foof: Send E) Gravel 0 Sandy Loam E] Clay Loam [I Clay ��Adobe E] Hardpan C3 Previous Application Made: (if yes,date--- -t -------- ) No 0 New Construction: Yes [j No [I FHA/VA: Yes [_] No F-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitteJ.4, public sawer, is available within 200 feet.) Septic/Tank-, Distance from nearest well.."- .... ...Distance from foundefion-ZO .............. MOttifial ....... 01639t 5� 4 .4"s No. -Of compartm4nts, Liquid depth—le ... ............ -Capacity... , -t tul Cold: Distance from nearest lot I;ne. 15` Dis Xihi� frorrilbutidation .... Distance to nearest Number of 'tf,,each 04.2.5 ��fh o� of french.......> --- -------- -- 71" ........ 0 ;1 ,Type.of filier.martirl _4 ...... See Distance to nearest'Wa>L...__.Distanc® f- oqndation-.--/-A ....... Distance to nearest lot line... 45� ........ - ----- mOu--! Number of pits.. .... Uptling materi Diameter.-,--. .P.?n P - Distance from nearest well ... �j '..Distanci from foul ation ....... --l-Uning . .. . ..... .... ❑ Size- 'A Lt-- .... 4 1, - 1.1-111.1. gals. ...... ......... Liquid Capacity_ ........... : ...... ....... iv Privy: 01itance from nearest Qisiancefrom nearest building ............... «......... 17-1 Distance to nearest. lot line ....... r� ..... ...... - I Remodeling arid/or r4ai ring (desc6i:m)L----, ..... ...... 0..4V*NVr, ------- ----- I . - I . . ..... . ........... . .. t."4 ... . .. . ...... ........... — ....... .................... hereby certify -that) have prepared this application and that the WOA win be do" In accordance WK San Joaquin County ordinances, Sta s, and rules and r ulafioft of the San Joaquin Local Health District. {Signed)._. ........... Contractor) ... ......... . .. ...... . ............ By:- ....... ...... . .... ........ (Plot plan, showing size of lot, locatian of system in Cie tow*-buNilll, em be pla"d on roverso itd4 at-, FOR DEPATMENT USE ONLY APPLICATION ACCEPTED BY.. .. . ................ GATE..Z-1'0....—..._....... . .............. REVIEWEDBY .................................. . .............. ........... ................. . . . .. . ... . ....... . ..... DATE.........................................., . . ..... BUILDING PERMIT ISSUED., .............. .............. — ------ Alterisficim and/or ............ . ............ . . . .. .......... ......... -1 ...... .............. . ...... *-- .. . ....... ..._.-....-.....,..«.. *,—** ---- - ---- ....................... . ..... - ...... . ...... . . ...................... . ............. ..................... . ...... ....... RNAL INSPECTION BY .... Date ....... ....... ............... SAN JOA1PUIN LOCAL.HkALTI-i,DISTkICT 1601 E. Hoxolton Ave. no 114 Symmoro Strom 205 West 9th street sfo6fon, Coulornio L", California )"nf*w, California Traty, California cis to slevisao 11-50 am 2--82 ir,^Ca.