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FOO vrI`ICE USE: APPLICATION Fbk- SANITATION KRMIT Permit No.a.4T39-1. (Complete in Duplicate) 12 ...... This Permit Expires I Year From Date Issued 1A1_1 Date Issued Z74C D lication is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. This application is made in compliance with County Ordinance No, 549. -7 2S, 0, t,' JOB ADDRESS AND LOCATION Owner's Name..... ...... Phone..._ ... .. ....... ...... .......... ..... . . ......... ... .............. ....... .Address ......... A�A� .... Al- ....... ,30" .......... Contractor's Name -.too .............. ...... .......... ...... *-*,*,: ...... ........ ........ ......... Phone.-..........,.......-.... Insfaliaflon will serve: Residence * Apartment House C1 Commercial [3 Trailer Court [] Motel [I Other ❑ Number of living units: .... .... Number of bedrooms ........ Number of baths ........ Lot size . ......... _ ............ - ......... ...... Water Supply: Public system n Community system [] Private C] Depth to Water Table ..... ft. Character of soil to a depth of 3 feet- Sand 0 Gravel F1 Sandy Loam [] Clay Loam E) Clay f -I Adobe n Hardpan 0 Previous Application Made: (if yes, date.. ...... No E] Now Construction: Yes ❑ No El FHA/VA.. Yes r7. No Fj -TYPE. OF .INSTALLATION,AND-SPE-CIRCATIONS: (No septic lank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation.._ ...... No, of depth ........... . Disposal Fie!d: Distance from nearest we!I.Ir ,.-...Distance from foundation.. . ......Distance to nearest lot Cc Number of lines .... 1 .........._.Length of each Width of trench... ..................... .. Type of filter material.4 _....Depth of fil Total langth-41".'... .......... Seepage Pit: Distance to nearest well, .. ....... __ ..... Distance from foundation..._.__.-.. Distance to nearest lot line.__... .-A . . . ......... Lining .......... Diameter... ............. Number of its V �,pool- Distance from nearest wall ................. Distance from foundaf;on..._._____.._. Lining -I Size: Diameter.. ....... — . . ....... .Depth ................... Privy: 0;stance from nearest well........................_.......,...........—.Distance from nearest building... ❑ Distance to nearest lot I' .................. . ............... Rerriode4ing and/or repairing jdascribe),Oue... _.. -7. .. . ... . ........ 11 ............. . . ..._.._.»_ . ............. ................ ................ ............... . ..... ................. ................................ . ...................... ........................ ... I hereby cerfify that I have prepared this appkafion and that the wort will be done in accordance with San Joaquin County ordinances, Slate laws, and rules and regulations of the San Joaquin Local Health District. (Signed) .... .. .... ....... and/or Contractor) .................. ......... ...... ............. ....... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY A APPLICATION ACCEPTED BY. DATE.. ...... REVIEWED ....... DATE BUILDING PERMIT ISSUED....... .................. . ......... DATE-__ ......... . . .......... . Alterations and/or ......... . _-....w._.............. .......... ..........,..». ...................................... . . ............. _ ............. ........ . ......... ................................ ............ ...... ........................ ........ . ... . ................. .................. .. . .... ....... o ................ ........... — ....... . ..... ...................... FINAL INSPECTION . . ........ . .... I I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F. WA"lt*n Ave. 300 West Oak sty*04 124 Sytomart street 205 West 9,0t Street Sfotktan, Califemic Led{, California r.p.cc.