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+CIW .. FOR OFF'CE USE s 3 7 GG ........... .... ... APPLICATION FOR SANITATION PERMIT Parmit No. . .!�Ll ..... IComplatw in Dupl;cafai ' Date Issued This Permit Expires 1 Year From Date Issued .r�•',..:�1:��.� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application is made in compliance with County Ordnance No. 549. -�% JOB ADDRESS AND 7lele LOCATION.....�f. I.�Q,X ..7�.r�.... �f ��,. Owner's Name.. ...........IC.I.iv. R... .....n.............. ............. _. ._�.... . ... . Phone_e�o!ez ..T.. . �.r�.i�b _ T. Address....... Ad.X71=._........................................ .............._..........................................:e.......................................... .......... ......... Contractor's Name.......$�i9 i"1 _ ................... ..... . ....:......... ... ...... ..._:r:... .......... Phone..._.... " . Installation will servo. Resldepce Apartment House e,6enmercial ❑ Trailer Court ❑1 Motel I D D..Q..�. ......... P ❑ Number of Irving units. Number of bedreams./...-'r uTbor of baths .../' Lot sae .... �... r.. Water Supply: Public system ❑ Community systam ❑ Pnva4a)g Depth to Water Teblo.?...Q ft. Charaofor of soil to a depth of 3 fief: Sand jV, Grevel❑ Sat'4 Loam❑ Clay Loam Q ,Clay❑ Adobe❑ Hardpan❑ Prevlaus AppRcafian Meda•. Ilf yesidpte.. t ..;J No ❑' New Construttion YesNo ❑j FHA/VA,Yes❑ No 13 r Al' 1 9 .6....�� TYPE OF 1NSTALLATION AND SPECIFICATICNS: _I (No septic tank or cesspool permitted if public sewer Is available within 200 feet.) y :ioptic Tank: ;lislcnca from nearest well...i`.Q.r...Distance from foundation /Q .Mattaly... QWVd.q.......__ No. of compartments... 2.._....._..._._Size....3 .X.9.......Liquid depth".::112..-......, Capacity.....,�G��.. Disposal Field: Distance from nearest we!L...SQ..'_Distance from foundation....................Distance to nearest lot rline.......... ,y^ Number of lwe.,.........tt_. .. ...............:Le-gfh..of each line..._...(0.0fy.........Width of trench._ ....7_..................,.,- Type of filter m.sterial__f2.04,.At.....Depth of filfhr material..../e......—...Total length.........00........................ Srepaoo P'.f: Distance io nearest wa!i ........ Disfonca frdm�foundaflor ................Distance to nearest lot line ❑ Number of nd3............ Lining siEterml '....Size: Diameter - ............'.tyep}h.. ... .......... Cesspool: Distant, f om nearest Hell... .... Distance from foundation ...._.Lining material................ ❑ Size: Diameter... y, f. .... . .... Depth.... .. ..>1 .....Liquid Capacity............................gals rPrivy: Mifrnce from nearest wail.. ....... .... . .... ......... Distance from nearest building......................... ............. D;t arcc +o nearest lot line .- - Remodeling and/or repairing I(lascr bad . � r's"^� .. k � QlJ a� ... . � ...- t ....sc ...... .............. .......... . I hereby certify that I have prepared this application and that the work wilt be done in accordance with San Joaquin ordinances, St�ate�to/mos and rules a d mgula>S as of the San Joaquin Local Health District. (Siysfo�l).../t! r/'t~•�...... .. . ....... . ....... . .. . ....... . .._..... . _ _.(Owner ."d/or Cen+/at4$ .., By:_..........._......f-........_.............' ............. ...._ ......... ..._Ti+leP................. ._ .. ... .. x (plot plan, showing'sae of lot,location or systom in relation To wells, buildings, etc., can be laced on remorse side s DEPARTMENT USE ONLY _— — c ��'-- APPLICATION ACCEPTED BY.. S•-!- ��""�'F^� ...... ... ..._.... .. . .... DATE zL' .'.F...:..{B{A... ......... REVIEWEDBY.................................. DATE.................._.... LUILDINGPERMIT ISSUED..._.............................:.......... :. ......_.......__.:.:.......:.....:.:....:.. DATE•,........._....__........................._.__...._ l.iteratiaes mWor recommendafiaas:...__. ._ —_.--___._—.._.- —__---- —'- --- '--- -- -�•, ;. ......................._..._..........................................—.............__................................................... y /. r 1r FINAL INSPECTION BY:.. c'1'.YC .. .... . Date. .. 4 o _,w JowWw Loin Hmat 05TRICT "at ILlk a No�ora tar au..... eco. k,=