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FOR OFFICE USE: r.,. _ ...._ . . ..................... ........... . APPLICATION FOR SANITATION PERMIT Permit No. 44!.: :. ....................... ..................... ......._ (Complata•i.- DuplieaMDere Issued ) L: �, _ .. .... _............ ..........._..__......... ... This Permit Expires 1 Year From Date Issued _ _ Application is hereby made to the Sen Joaquin Local Health District fore permit to construct end install the work/}1Q"escrbed. This application is made in compliance with County Ordinance No. 49. - / Y y 5' I ��— . �. lSJOB ADDRESS ...... . .. . ... SOwner's Name�� .y........... «....s.... v .. . .f.. .......f... Phone............................ a Address.........J..! �Il......... .n .�... X / ..... .. .... t� Contractor's Neme......_. .6!�G!.-/.G..�p.T,r....:_... ... .... ......................................... Phone.......... ..........f� �s /j 1 Installation will some: Residents, ❑ Apartment House ❑ Commercial ❑ Trager-Gourt ❑ Motel ❑ Other• Number of living units: ,`... Number of bedrooms.. t Nu'mbbeerrof baths%4T.. Loi size .y.�(fl�.97. Water Supply: Public system [3 Community system ❑ Private Lr7 vepth to Water;Table%gQ it Character of soil to a depfh of 3 fcef• Send❑ Gravel ❑ Sandy Loam 0Z12lay Loam❑ Clay❑ Adobe❑ Hardpan❑ Previous Application Made: (1Tyes,date.... ...... .... ) No Rv New Construction: Yesi❑ No�'FHA/VA: Yes ❑ No Q--"S TYPE OF INSTALLATION AND.SPECIFICATIONS: 4� : ak2 jifo septic tank or cesspool permitted if public sower %available within 200 feeA{I • ' S^piic TaA:r- •' Distance from nes esi well _..............Distance from foundation...... Material - l6` T L• ((ygs6 No.\f compartments ...........Size................... ...........Liquid depth ... ..._. Capacity .. yr' Disposal Field.' Distance from neeresj Y'_ !I a�Q.��Distance from foundation.. ......Distance to nearest lot I1ne��Q Nurt;,ar of lines .eW t. ...... Length of each line.30! \Nrdth of tmnccb, �t-. d . Type a.filter..myteral ' Depth of filter material.`.../r Total length.:`._w7 Seepage Pit: Distance to nearest//JwJall �r .....Distance from to dafion P.�4�' ....0,t to nearest loo 1me�dt /� [s]� Number of pits... 49.......... Lining material.,.l�QCs't Size: Diameter Dep}h ' a'J ¢ esspool: Distance from nearest well. ..__..... Distance from foundation ... . .Lining material .... a7( ( ❑. Size: Diameter... ............. ... Depth. . ........ - ... .. ... Liquid Capa ;fy.... ... gels i Privy: .f Distance from nes resp well. .,i.......... _..._ . Distance from nearest building. . ....... ❑ Distance to nearest lot Irne _/�1 (/J�j -.-.. - ..... Remodeling and/or repairing (describe) a.•fi' A.,7VN1J� .................................. ..... . ... ..... _... ................. ... _............................................................._.. ass ............................ . .........._..............................................._................. _ . . ._... .. ... ............................ ........................_..... .................................................... I hereby certify that I have prepared this application and tha}the work will be done in accordance wdhSan Joaquin County 4 ordinances. State laws, aid rule and regulations of he San Joaquin Local Health District (Signed).................. ... _ ... ........ ...... ---__.(Oroopio0 Jar Contractor) Byc....................._.................._.. ........... .. .... (T'i}le)... / Q,./... .... _.... (Plot plan, showing site of let, location of sysfen re afion to wells, buildings etc., can be placed on reverse side).- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY../,,..NL/ -GtI� - .�. ,1. DATE.: . ./t�.�� :b(T REVIEWEDBY................ ... .. / _ .. ...... ... .................... DATE........... ......................................... rt BUILDING PERMIT ISSUED....................../`}"f......./V�,f....... ...... DATE................................................. _'....... :a Alterations and/or recommendations:. .. .. .. _..__.. ........V11112•+r. ...................._.. ......... ... - ...............................__........_ ........ .......__...... ................._...._........................................................I............ ....... .:.....: .......................................... _..... . . ....._ ... ................... .... .. ........ ....................... ........ .... I........................... . ................................................. ............ ..........._............._............................. FINAL INSPECT:CN BY:.. j.M/. ...!Tc. Date...... AO .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nsalfen Avr. 300 Wr0 Onk Stru; 174 srmmen Sbuf 205 Wrrr 91lr St.., Sredten,California Led; C.W..Ma Mnnb,a,Celllernla trap,Calilernia ' E.H.9]M 1 07 %'a,Iuc,4 P:p,