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r. FOR OFFICE USE / ,y Permit No. K=-•�•- - »- I APPLICATION FOR SANITATION PERMIT Rte.; "" '-•••' (Complete in Duplicate( Date. Issued - '.•� - "-,- This Permit Expires 1 Year From Date Issued l Health District for a permit to construct and in<ts::the work heroin des Application is hereby made to the San Joaquin Locaabed. )--`This application is made in compliance with County Ordinance No. 549. �' v _ •,` J08 ADDRESS AND LOCATION.Lsr..PAIR-%'... ,; • one.----- _-••'_= 1`1�?....f�,�hth+ __...:-.---._.._......._-_-....__..._------------------------ ------ .. Ph Owners Name_.-.. . Address _.-1frr�.!-1_L.._..___tG.:..6.cai�-k.lrr=S<___._...____.......�-..--.—.__...._.�.._.�._._.______..- LORIt�Ie......................./..L..S...Zm�.... !e(/.11�7Ki 1�....__ PhonsBQ S4Lz� _.. Contractor's Nama._._.-._....._.-,...._._ Motel ❑ her ❑ 5+ - / Commercial ❑ Trailer Court ❑ Installation will serve: Residence r�pehment House ❑ - •:;:;:. r,r1� _... Lot size Number of living units: ...I•- Number of bedrooms..I. Number of baths .I Wafir $upply: Public system ❑ Community system ❑ Private �Oepth to Water Table .Ip ft. Adobe�iardpan❑ - J Character of sod fi•depth of 3 feat: Sand ❑ C-revel❑ Sandy Loam❑ Clay Loam❑ Clay As Yes No LT . a;.... New Construction: Yes ❑ No FHA/VA: ❑ . ":.Previous Application Made: (If yes,dote......... No [[� /YL yri• TYPE OF INSTALLATION AND SPECIFICATIONS: _ ar is available within ton feat.) -(No septic tank or cesspool permitted if publicsaw _ r Distancn from nearest wellgI&Q-•.-•Distance from foundatio ..1Q.;-----Mat Septic Tank: q..._._...Size..:f..'.'..I9^...4/i._Liquid aepth...... �i/........._•Capacity_ No. of compartments------._.oG- . r \ 1 s . Distance from foundetion..14.___....Disdth M nearest lot�ine..tl�.._-.- =-0aposel Field: - Distance from nearest well._, GKZ--- �p'_----•-Width of trench._s�y--•---•-- Number of lines--------199. ..........---•---Length of each line_.... .... s Type of filter material...' �° `• Depth of filter ma}eriaL.../-.8.__....._..Total length-_-.�� ---• yP p........_.... \ • Distance to nearest well.......... Distance from foundation..._..__--Oistence to nearest lot line._..._ Seepage,Pit. ...._.De th_....._.,.,.._ . '+ Number of pits...... ..............Lining material Oiametar..........._.. P ❑. -si'- Cesspool: 'Ostanea from nearest wail_...»._»-._Di:Tance from foundation..._.......--..Lining .rgwd Ce meta --= --••• -' ❑ SiL%-. Diameter.._................._...,......_.Depth.._._.._..-.__._........--...___ ga_..____---------g Distar.ae from nearest well...._._<-----•-•••- ••-'•'-Distance from nearest 6uildin - Privy: n Q - Distance to nearest lot line...._._... ._.....--------------- Remodeling end/or repairinc (describe)::....................... _ .-__......- ---•--- _.__.._.__-_...__.-......_-..". < ............. with cart that I have prepared this application and that the work will be done in accordance with San Joagwn County _ yr " ordinances. State laws. and rules and regulations of the San Joaquin Local Health District-Y--.-••(Owner a r .;c ned 4lsyr�r�-.....L. '-!&fit.Q........_...._...--•-•--.._..._ .. -- 9.:: a�- _ - ____ .._._._....._.._...._.....__.__..._..etc ar Contractor) (Plo}`plan.showing sire of lot, location of system in relation to wells, buildings, etc-, can be placed on reverse side) »��-'• FOR DEPARTMENT USE ONLY 3'a APPLICATION ACCEPTED B DATE..__..-------••--'--` '-'"- REVIEWED 8Y_.._._---._... -.... ......._.............__.__.__...._._..__._..___...�..__._..-- BUILDING PERMIT ISSUED.---- --------•---- ---- .., Alterations and/or racammandations:...._.._.............._......................_._»._.._.._...___...-...—.__------"--'•-- - -- L...._.._...__.— ..._ ... - .........._.. ......_........._..._.....-""- . _-....._..-.........__._....... i :., q Defer...... _.Q�-4.._.__...._...._.............__....- FINAL INSPECTION BYE/1ps•n-� SAN JOAQUIN LOCAL HEALTH DISTRICT :•-� WI,Cala•rnia am• : les W.11.Cr a9l1 LhnAmr..•u 300 Wu paY$eu 124uSlm1 IMI L tro<v, -