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FOR OFFICE USE: .................. _........_ _ APPLICATION FOR SANITATION PERMIT Permit No. .ZZ=A �•`- .. _. .._ - ............ (Complete in Du rut. P I Date Issued ...__._.._....-...- _._ . ......._.-. .. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for is permit to construct and install the work heroin described. This application is made in compliance with County Ordinance No. $44. JOB ADDRESS AND TICN_�n / i !' _.5�. .--..-....:-.:/1 �1�..�, ... . .......................... ._ - ... Owns%s Name.._._��t. .: .:4?�-�' ........_,.._.. ............. ..__- .........-. �:...../'_.......--•-----/..,._....�._g_.__.._.. Contractor's Name..... .. .^�—�t./`� ' .`.r�. �1 ..._...JR!..-->�r...... ... Phone:? Installation will serve: Residence Q11.Partment House ❑ Commercial ❑ Trailer Court ❑/ Motel ❑ Other ❑ Number of Irving units: . :. Number of bedrooms_� Number of bpths ........ Lot size ........... Water Supply: Public system ❑ Community system ❑ Private B- uepth To Water Table ........ ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ ardpan❑ Proyious Application Made: (If yes,dote...... . ...) No El New Const•uction: Yes ❑ No FHA/VA:Yes❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No up tank or cesspool permitted if public sewer is available within 200 feet.) -c Teak' Distance from nearest well..........._....Distance from foundation...................material......_.................__..._.......__.... C: No. of compartments.........................Size................................Liquid dep,h........................Capacity. _ / "'..jstance to nearest lot line../ Drr6osa � Distance from nee t weIL.LC.O_r..Distance from foundation.. ..r ._ `•�•-'• }moi. Number of lines.-.. 9 - y. - -. Len th. or each lino./L!c.....y...L..•�Widih of trench.. -�.;a... .. "� - Type of filter meterial�/.frc.. Depth of filter materia)_/f..'..=........Total length.......:Z..'rsf-••••-.-__.-- paq it: Distance to nearest well.....................Di0once from foundation..................Distance to nearest lot line._..._.....-._ Number of pits..... ...............Lining material.. ........ Size: Diameter.........._...........Depth................................ Cesspool: Distancefrom nearest wail........._.....Distance imm foundation,......-.........Lining mafarial_.................._....---- \k els. ❑ Sim: Diameter.........._..__------_.-.------Depth........._.-. .._.... .... .....................Liquid Capacity....._.............._—g Privy: Distance from nearest well........ ......... ......_..... .. . _. Distance from nearast building..._..................__..._......... ❑ Distance to nearest lot ,,,line............................. ............._............................._._......__........... Remodeling end/..r repairing (describe { r -- ....... -._. ___..�..._ .. .prepared P .-......-_........._........__- . ............_............. ..................................-......-.....-.-..-.._-..... I harsh Cort' that I have ro ared this application and that The work will be done in accordance with San Joaquin Coun4y �p s ^ - tins of flip San Joaquin Local Heal}lr District. Sd'menees, fs and r �d�regulafi Y �.... �� .. ......... ... d/or Contrasror) m of.lot.._. . )plot pian,showing saize of lot, location of system in ra!!ilton to wells, buildings, oic., can be placed on reverse side). FOR DEPARTMENT USE ONLY — APPLICATION ACCEPTED BY /� "ice i :rte" -- - - --- ------ DATEm.,' / L•. - --..- REYIEWED BY .. .........._- _ _. __.. .._._. DATE... - ..-_ .... BUILDING PERMIT ISSUED . . .. . ___.... _ �. ... .. - DATE........._.. -. .......___._ _. .. ....___. Alterafwns and/or recommendations:. .. . ...._. . ........__....__.__.........._.__........._......._._..... ...__........ ................... ......_....._._...__- .. . . _. _....__ FINAL INSPECTION BY �. .. .C"�K�-/�s�-.- 3 ✓ Data. "'.. ._._. .. ... _ ... ............_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 S..1h Aauinn Saul 700 Warr O.h Scour 172 Srcamen s"..' 705 Weir 01,W*91 Srodren,Calilsrnla lodl,Calilernia Mamr<a.Cmllornia Trory,CalBernla ES 9 nEVISED 9.57 2" 5.62 ATLAS