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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .. - .. "-" (Complete in Duplicate)--- This Permit Expire 1 Year kom Oab lewd Application is hereby made to the San Joaquin Lxal Health District for a permit to construct and install the work hereiate inescribed. This application is made in compliance with Count/ Ordinance No. 549. JOB ADDRESS AND LOCA77��p� yr jFf Owner's Name. .r . . .. . �^ -. ........�....................................................................................... Adraw-._ - . ......_............ e.Contractor's Neme............. ........._........................,.,......• Installation will serve: Residenceigi- .....�� ...r....... Phone..........._............... partment House ❑ Commercial ❑ hailer Court [3 Motel ❑ Other ❑ Number of living units: ... Number of bedrooms 2.. Number of baths.Z.. Lot siz �y�of Water Supply: Public system ,-."� e�//^,� ..'...................................... .. Y ❑ Community system ❑ Private LsS 1/epfh to Water Table�fl/tt. Character of soil to a depth of 3 feet: Send❑ Gravel❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe ardpan Cl Previous Application Made: (If Yes,data.............__..-) No New Construction: Yes ❑ No LE)'FHA/VA:Yes❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) $ tic ie �! Distance from nearest well.................Distance from. foundation....................Material................. / /n7 No. of compartments..........................Size................................Liquid depth..........................Capacity.........-.............. Disjuosel-Fi Ids Distance from nearest well.................Distance from foundation................ Distanco to nearest IoIine...._.....-..... I�WG ` Number of lines-..enol.........................Length of each line..............................Width of trench................................... Type of filter material.........................Depth of filter material.......................Total length......................................... Seepage Pit: Distance to nearest well...`.....,.Distance fr fou dation- Number (D�• Number of pits.....,...........-Lining material.- G x -'•--Dist nce to nearest lot lin ------ ffes�^^ �+ i /41Y . _Size: Diameter-.. .y lin Lining 6 Cesspool: 9.........Deptha?s�................... ....... ........ ! ❑Poo Distance from nearest well............... Distance from }oundation....................Lining materiel..................................... U Size: Diameter..............well..................Depth......................................... Priv . -.........Liquid Capacity............................gels. ❑Y Distance from nearest well..................................... ...Distance from nearest buildin Distance to nearest lot line. building.......................... Remodeling and/or repairing (describe):—................. .. ......................................... ..................... .......................................................... ......... .... .......................................................................................... ..................................................................................................................................................................... . ............................................ SL hereb certifythat I have application ...................................................accordance with prepared this n if tha.n end that the work will be done in accordance with Sen Joaquin County ordinances, fate laws, and rules and /�re�gu�lati�onjsj�of }he $,en�Jjoaaqui��. Ljo a H alih District. (Signed)........................................._..._!f"'.'-...^i- ..a/</�i"F�� -..Owner and or Contractor By:..................................................................................... (Plot plan, showing size of lot, location of system in relationa. to wells, buildings, et , can(bel placed on reverse side). FOR DEPARTMENT USE QNLY APPLICATION ACCEPTED BY...... . . ... •S REVIEWEDBY.................._....-. ...... ................._.......I..._.. .- DATE....1.r._�1.,...6.5--.-...._......._._........ ...._..-...._................_.---........_.........._................................ DATE.._........................_...-. BUILDING PERMIT ISSUED.......................................................... ................ ...................................... DATE...-.. Alferetions and/or rewmmendations:...7.-..r'1-�.b.J'.............. ...... "--'•....r.......................... ........................................ . :. u7f .... _................ y� y J.... t I _ ..Cn.w.(y. 4.. �r Yrl.................. .a l .................. _........... ...... . FINAL INSPECTION BY:..... Date SAN JOAQUIN LOCAL HEALTH DISTRICT I601 1.IMtNbr,Ave. 300 Wen Oak 51,.ar 124 Srwmen Sr,ee, 105 W-0 911,Sn..r parWan,GlihmA leei,California 205 Celllemle a peo retry,Caiilernia