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FOR,,CFFICE USE: <br /> ............ ......................................... <br /> APPLICATION <br /> _,PR -SANITATION PERMIT Permit No. <br /> ----- <br /> ----- -------------------- -------- (Complete-in Duplicate) <br /> ........................................................ This Permit Ex Date Issued <br /> Expires 1 Year,From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora—permit to construct and install the work herein described. <br /> ,This application is made in compliance with County Ordinance No. 549. 2ys- 0&0-30 <br /> J I <br /> B ADDRESS AND LOCATION.---M1—Si ......................... <br /> -- -- ------------------------ Phone.. --------------- <br /> Owner's Name..------ <br /> Address <br /> ame-------- <br /> Address.............................FKQ, 11­5funl. . .... <br /> ---------------- ---------- ------------------- <br /> Contractor's Name.-..-------, '.-- ...... Av.......... ......... <br /> Installation will same: Residence [] Apartment House E] Commercial 0 Trailer Court [I Motel Ej Other 0 16'r- ,Aftj <br /> Number of living units: .. ..... Number of bodroitims ....... Number of baths........ Lot size ..... ... ................................................ <br /> Water Supply: Pu6lic*Vysfam C] Community'system n Private Depth to Water Table 5k. ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel El Sand Loam)( Clay Loam El Clay El Adobe 0 Hardpan C] <br /> Previous Application aade; (if yes,date... _...l........ I No New Construction: Yes No ❑ FHA/VA: Yes E] No E] <br /> A <br /> MERFINSTALLATION AND SPECIFICATIONS: <br /> IN _d <br /> J <br /> septic tank or cesspool permi}}e�c^if public sewer Is available w1+FinO'�feet") - <br /> Septic Tank: Distance from nearest well.IA......Distance from fo6_ri2Ib,95ir=A.0_...Material ............................ <br /> No. of compartments.......... de'pi:h'�'.5k...........Capacity... <br /> Disposal Field: Distance from nearest ......01i s'tja nc e from fRqndaficn#.....1_4J .'_Yistance to nearest lot line--------- <br /> bt Number of lines_._._._f_?---------- .............Length of each line:. .....3017- <br /> ----!:....Width of trench... ......3......f............ <br /> fh <br /> Type of filter Depth of filter m`a�+eriai?A_c7c1--c.........Total length -- ----------------✓10----------------- <br /> Disiance to nearestwell 1, 45'r----.Distance <br /> Seepage Pit: -,Distance kom joundation___.;� ........Distance to nearest 18t line._.___._.-.. <br /> Nu M�ber of pits. ._'-Liring rnaterial._fK6'.rk------ Size; Diametepr_-W."'-----.Depth_.... <br /> Iyy <br /> Cesspool: Distance from nearest well...------------Disfance4 from foundation..... ...... __ Lining material.................................... <br /> 0 Size: Diameter... ...............Depth---i .........--------------;..............1K-----Liquid Capacity.........--................gals,4 <br /> Aro <br /> Aro <br /> Privy: Distance fro;n.nearest well!----------------------- 'ek 1 <br /> - -------�khistanqc)7froi- nearest building............,'....................-............................... <br /> Distance to'hearest lot liner:.......................................... ........ ......... ..............................................................i.. Vi <br /> Remodeling and/or repairing (describe):......_.. --------------- <br /> ----I'll <br /> ----------- -------......................------------------------------------- <br /> . ............................ ...........-_--------------------­...........------....................... - -------- ­-- ------------- ­­--................. ............... .. <br /> ........................... -----------­­­­..........---------------­-----------­----­----------------- ...... -------- .......... ..................................................... <br /> ......................................................... <br /> I hereby certify that I have prepared this application and that thelwo$rV will be done in accordance with San'Joaquin County <br /> ordinances, State laws an rules nd regulations of the $an Joaquin LocalHealth District. <br /> (Signed)------- <br /> ...r71- ...............AOwner and/or Contradirl <br /> ------- .. ...... <br /> B;:L....... .. <br /> (Pio} plan, showing size of lot, roc of ,jsystem ells, buildings, etc., can go placed on reverse side.).n relation to w <br /> 'FCf1R DEPARTMENT USE ONLY <br /> . . .. <br /> APPLICATION ACCEPTED By__`T-i --- <br /> - ------e!7 --- <br /> - -- <br /> �..:! DATE..... <br /> .I- Z, 1!1�41t --------------- <br /> REVIEWED BY._............ -----------------------f.­­..............I............................................................ DATE_.. .............................../ <br /> .......... <br /> --- ............ ...... ---------- ........ ............... <br /> BUILDING PERMIT ISSUED---------------------------------------------- DATE. - <br /> 1.0......0..................0....... -----------------­0...... ......0.1........ ...... <br /> Alterations and/or recommendations:._ ........./.................... ...;ioi <br /> .........f� ­.­ <br /> .............0......0........ ------------ .. ..... ....................0.......... .... .......... -------- ............. <br /> ......................................... .. ............. .. ........ ............... <br /> .......................... <br /> .........................­­------------- ......... .... . .......... .............Z.......... ....... .......-------------- .......Z <br /> ...............*........ <br /> FINAL INS P Date.........-._...l...:.-. ' <br /> ---------- <br /> ............ --- <br /> —SAN JOAQUIN LOCACHEALTH DISTRICT- <br /> 1601 E.Ho.olton M.. 300 W..1 0.1,Stt..l 124 Sy,am.r.Sl,i,ot 205 Wel 9th Sir.0 <br /> S19,ki..,California I..& California California T.cy,Calif.r.la <br /> E.N.92M 1 67 V.Igu.,d F,.» <br />