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FOR OFFICE USE ��. .. .................... .. 1 a �.` • APPLICATION FOR SANITATION PERMIT Permit No �l/Jf' _ RH. -•- - ose le YearFrom ocm Date Issued Da» Issued ...... .... ..... .. . This Permit E � Arplication !s hereby made to the San Joaquin Local Health District for a permit io construct and Install the work hero .cubed. ice+� This application is made in compliance with County Ordinance No. 549. - 7Jl �• JOit ADDRFSS,AND LJ I Ow crs Ne.Tte.�...� .......�y ............................... Phd+a .. r'.: ........... . - .. .:..... .....Conrdme...� � . ....._. one.. v< !mfe�efion wws7`{{e i'.'�Reriden_u g4l Apartment He-,so Q Commercial[3 Trailer C:Trt [3 Mole! Q Other Nurcber♦f living unite:_�:::'Nslmbe:e,bedrooms.2, Number of,baths . lot;size...../Vs...x....�Z.r:•....... Water Su Publics tem [ Commun' system Privates De th to Wates Table.9.•. ft. PPIy: Ys rI �rtY-. Ys ❑ � P Character of s9-te a depth of 3 feet: . Sand lr Gravel Q Sandy loam Q ::;ay LOJm❑ Clay❑ Adobe Q Hardpan Q Prev;ous Application Made: ill yes.dote ::......... .:...)`I o 0, I16w Construction: yji�yamf. No 0 FHA/VA:Yes Ea—No 0 TYPE OF INSTALLATIOk AND SPECIFICATIONS: No sopfic tank or cesspool permitted if public sewerit avenable within 200 feet) j Septic Tank: Distance from nearest w !]....,.T E� Dlitence frofrl foundation.../C i- ' s'Me erial...L.l. � til"+ ......... p®' No. of canna?men'_.., X./� _Sae. ....._._..._._Liquid dipth.. .........Capacity..r1 'G�r i Disposal Field: Disfexe from nearest_well.... S ...Disfance f-Qm fgug6f�i�on,..-60x._.1....Distance to nearosT lot line... - �], Number of lines....__ Lengthy of nach me .T. 4EWidth of trench.......4�...I......_ .. Type of Filter materiat..l�O. .L:ti...Depth of filter material...... . .....Total length.........,��C,I.... Seepage Pit: Distance to nearest well...._............_D:stance !romlfoundetion..........:.?.....Distance to nearest lot file... Q Number of pits..............Z. LininD material.............s.:._.Sae7sDia.nailer................. ....Depth.... .. . .._ ..... K r •: i Cesspool: Distance from nearest well........ ._....Distance from foundation..........f.........Lining materiel.................. ................. CI Size:"Diameter.... ......Depth..................w............. .. ......1..:. Liquid Capacity......................:_._gals. Se Privy: Distance from t re"iM wL"a .... .................. ... �S�sf'nce from'nderest building ..._ .._.......... �{ ❑ Distance to oe?erui lot Lne..a 4•r. xa'.�.a ---•j`•1•••-....... �. . �n -F Remodeling and-ror repc:ring (describe:........C'.'P .D..�:Jl./Y.f.'fl../.3.(Yl t,.rJ 13:� :.._.../P,IJ zQ...'........QLf!v.....rv,L zrl... Y�Yla lT.nl ..........T,.L,.:.2•..................... ...... __ ....._.........__..._.... .... ......__.._....................._................. ............_............ ._._... _....................... ...... ...._...._._.........._............ ........_..........• ._.........,......................... :_....................... ................._....................:..:..._....::.......:.......:........_.::._ I hereby certify that i have proper }hls'TpPLu'ffo'ii e`n`d-fftaflice wort wlI be done in accordance with San Joaquin County ordinances, Sfate laws, a rul,, and rP�efions of the San Joaquin Local Health District ($)quad .. r,/C�.. / Q• nor Contractor) ' �F•yI�"./.�.jyy._/. ...]^•Pllz�....... ........ .. (Orr end(or ctor� ....... .................... s . (Plot plan, ;%rmfnq size of lot, huf of sysfem in rotation to wells, buildings, etc.. can be P'-...d on reverse sSdej. FOR DEPARTMENT USE ONLY APPLICATIOACCEPTED BY=._:T.:1:.�'j-L?. _.....: -. _:::.: -- DL1TE.;; .✓,�- .•...-....... . t4 •� REVIEWED BY ... _. . ... :. DATE .......... BUILDING PERMIT ISSUED............ .. - .. - DATE ......._.. Alterations end/or reccmmenddions..... /Ifl..'.F .�f�flP'r�F�?.....�/V .3ff�r....7.•.:....... S.:.f.7..... ............ ................... .... .........__.......... ....._.._..........................._..... ........................................ ......__. .._......_._......................_. •...�..._....r.,,�� 1.;......... ^t .... . ...... ... ... ...... . .. .- car/ ............. .. �. FINAL INSPECTION BY.Ak r1.%/a .7_. ` -,C�;�(".7 7 Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1e01 s.eareMe sea• 000 W.,,Oat L•«, 124 loot 205 W.,1 f,F Sn.a Le.aler,.b11b,nA le0i.C.IilarNe MsnUm.C.deornla Tre<y,C.iil.rni. ca •ec.•uo•-se a+a•ea r n eo.