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j 1 FOR OFI=1 E USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate( d�•1.3�� 1, -.- Date Issued This Permit Expires 1 Year From Date Issued /..................... ' AFplicafion is hereby made to the Sen Joaquin Loral Health Dill rict for a permit to constru:t and install the work herein de_cribed. This application is made in compliance with County Ordinance I,o. 549. JOB ADDRESS AND LOCATION../QZ4047..../Y..-._.W.._L.:[ ve791d10re-,efVr. ................................................._...... ..... Owner's Name..... ....'ArsfC?.(.ILOLIT._._. . _ _..._. _........... .........._ .... Phone........................ Address.......sS'..Q./1J.ti......................_........................................__........................................._.........._........_...__...__.__.._.............. f A Contractor's Name...._X-10re...:.LC.1r�l.L. .................. .................._............_............................ Phone.............__.........__.... Installation will serve: Residence ❑ Apartment House ❑ Commercial iy*�bailer Court ❑ Motel ❑ Other ❑ Number of living units: .'].. Number of bedrooms . Number of baths A+ Lot size /.lis`G...................................._ Wafer Supply: Public system ❑ Communiry system ❑ Private Depth to Water Table ..1r ft. Chara:ter of soil to a depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe 13"Vardoan❑ Previous Application Made: (If yes,dote I Ni, 23' New Construction: Yes ❑ No (a7i FHA/VA: Yes❑ No Z�-r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.( Septic Tan v Distance from nearest w0_...__ _. ..Distance from foundation................... ................................................ V0`0$ No. of compartments...._.. _._ liiz6........_.........._..........Liquid depth__......... .........Capacity._................. . Disposal Field: Distance from nearest well .Distance rrom foundation....................Distance to nearest lot line................. A-TalIS-fir Ky Number of line:............... ____ Length of each line..........................Width of trench.................................. I f Type of filter material....._. ..... ... . .Dapth of filter mater:al. ...................Total length..............................._........ . Seepage Pit: Distance to nearest well/.30..... .Dlstonce fr mfoun.dafion_�Q..�.._..DisTance.to Ilearest lot Number of pills... Z ._.Lining maferial../kw�'4>.Size: Diameter... 3.'.� lina..lar�.......... O Cesspool: Distance from nearest well........ _. ..Distance from foundation. . ......_... Lining mater,d! _........._..................... ❑ Size: Diameter.............._ Depth. _. . .. _......................___......Liquid Capacity............................gals. Privy: Distance from nearest well. .. ... .. . . ..... .. .. __.._..Distance from nearest building .................................... a ❑ Distance to nearest lot line_ Remodeling and/or repairing (describe): ,?,-IV�!.Yfilllr9sT�..' ... _ .. ............ ... ...... �f� .........._.... . . .... ...._ ........... .......... . .. �) ....... ..................................... _.__. . .__. .. .................. . ............... _ __.... .. _ . .... ... . .. .. ..... .................... L� 6 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaqui:� County ordinances. State laws, and rules and andreregu!ations of the San Joaqulr, Local Health District. (Signed).. .. ... ..../LC' /G' .I %�.}"''Q �. /,. __. .... . ...(QwnerawdJor Cunha^tol}L By:. _ _ c .y ."L r. ti li�/!ft!/" ._ _. . _ (Tilly_ cG✓./662 side). �`J\ (Pio]plan, showing sire of lot, location of systerry ire e#ion}e Walls, buildings, etc., can 1.s placed on reverse aide(. - x FOR—DEPARTMENT USE ONLY APPLICATION ACCEFTED BY E r.' `tl. - - ._..._........_ . DATE /0 -'' C- REVIEWED BY. ._. _. _...... .. ..... _. .... DATE BUILDING PERMIT ISSUED_.. ...............__ .... .. . . .. _. _..... ._..__ DATE.. .__ _._. Alterations and/or recommendations: _. _ ... _..ICI . FINAL INSPECTION BY: - Date _'I cl- lf�,? SAN JOAQUIN LOCAL HEALTH DISTRICI 1601 E.tlanllan Ala. 30C Wal oa5 S.,u' 124 Srcemn•r Slraal 105 Wast 911,slraa r 51.61.1111 C.1"Wie leis.,Calif.-.. Menrrm.C.I,r.rnia Treq.Cnfil.rnia �' CS 9 eCr.'v LL L i'r .r J'4] r e Ld