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FOR OFFICE USE: APPLICATION FOR SAMITATION PERMIT Permit No. ;oeplele is Duplicate) Deb Isued This Permit Vxy4es 1 Year From Date Isswd ........:...J.li/ Application is hereby made to the San Joaquin Local Heehh Dio!,-,ct,for a pannit to construct and Fsstall the work herein described. This appfcetion is made in compliance with County Ordinnn<o No. 549. JOB ADDRESS ANDSsL�OCAT/ION._../�Zf�O /IG�' /�ifi./"`111rcC G7--.. . ..oS.//�i ........ 4— Owner's Neme.... C/.:.A:: . ................ ..__. r -/2222 .. 22....... Phone........__...__.........._... Address.........(/............ 2222.. ....... ...... ....................................._... �..._.. Contractor's Name.. ........ �J J� 2222 Pb. < ......_.............._......_.. /f'd` •s�..�.� �2.:.. ._..__2222.. _ 2222... Installation will sena: Residence &'Apartment House ❑ Ccmma-,cial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. .. Number of bedroorni",Z Number of baths Z... Lot size ..ta3�7„I��k.y....�._..................... 'Hater Supply: Public system ❑ Community system ❑'•Prive)e li�j-pfh to Water Table ::Vert. Character of soil to a depth of 3 feet: Send❑ Gravel[] Sesgy Lcam❑ Cay Loam❑ Clay❑ Adobe 911011ardoen❑ ; Previous Application Made: (If yes,dote . ) No. Nrw Construction: Yes [L1�No❑ FHA/VA,Yes 29--"`N0❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicw seer is ava;1.41-within 200 feet.) Septic Tank: Distance from nearest well,.AzeDistarce fn.n. fou,,dation.... M fer�•ait-.e,-4/46PW4;4�........ '• No. of compartments. �. ;,�:e+�L/ �• S/f.._Liquid dopth... ...�G,-�_.... Cepecify...J�AAIP.... I i Disposal Fiold: Distance from nearest well/�� •O�s!nocn:6d�. .'oundefio ._./tf�.........Disfencs to nearest lof�inss�......... (jI/ Number of lines_.....� 1 ng!h o; rn F line..� -�_ Width of trench. �.......................... Type of filter material�!�/t`C! Depth df filter meleriaL../ �....�Tofal Seepage Pit: Disfar ce to nearest well love, .i Distance Goin iour}detioa..f.`1.7..'isf fee to nearest tqf Nwmbor of pits �_.... .._...Linirg materiel ,rt lb'.. Sizo: DiamofersA.. ..-_......Depth.:2207..,.................. Cesspool: %Stance from neat.--t well... ..._ Dis!nrc� f._r,„ 1„undafion 22 2_2. . Lining material_.._ _............................ 0 ❑ Size: Mamefer. Der ......_.`_.Liquid Capacity........_.................gals. 14 Privy: Distance from ncarcst wall Distance from nearest building 2 2 22... _................. ..... .. ❑ Distance to noare.t lot firs //.........._. ........._ _............_ _ 2222_..._.....__ Remodeling end/or rerairinq (describeJ: . `7"ec-,. ' s.�1BF'� �fCGew.'Li+t9C0....................................................... 2222 _. ....... I - ..... . . ...... i. ._ .. ..... ... .. . . . ... ... 2222. ..._ 2222..._ I hereby certify that i have prepared this application and fl,,f rk,.work will be done in accordance with San Joaquin Counfyn ordinances, Slate laws, and rules and regulations of Mn Sen J 1 Erol Health District. V^l� (Signed). �iZ• / 2222 to-omaod/or Contractor( (Plot pan,showing ties of lot, location of system in -tion.Io tis,kvildirgs, late., can be placed on reverse sWeN Vl — FOR DcPAP.ir 1PLY 1,i517 ONLY APPLICATION ACCEPTED BY •'• . DATE... .. .....'..:. �. .�.:_1,'.I. . REVIEWED BY .. 2222. __ .. DATE. . 2222.. ... ....... BUILDING PERMIT ISSUED.... .... . ,. ! - DATE 2222 2222 t, .. Alterations and/or recoremendat ons. �' i FILIAL INSPECTION BY: SAN JOAQUIN L"' ;. '.' fH DISTRICT 1]0 Swrh An•,Iten Lvrl 300 Wol Oes A.w N Snwnas•Srrarl 205 WN 91h Lrwr SU,Han.CehlOm�e t+di.Calae.n�� +m.Cobrwnle M1aq.Celllon�a