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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �i , /GG Data Issued ...._1.............. Application is hereby made to the San Jcdquin Local Health District for ape.mit to construct end install the work herein described. This application is made in compliance with County Ordin No 549. JOB ADDRESS A CATION,.-(s�/ ... .,,el dyj/(��. �� _ Owner's tJarre...... .. .-N.. ..........._ .�N ..........---- ---...... _.. Phon Address......... - .- -!r}....... - ...... ...... ..... ........ .............. .................... �s _ ........ Contracror's Name— ... . ................ ....................._.....- �`a _.. ._................. ... ....... Phony Installafion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .1._. Number of bedrooms Number of baths .1.... Lot size Water Supply: Public system ❑ Community system ❑ Private J�LDepth to Water Table ft. Characier of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam dtf Clay M Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No §� New Construction: Yes X No ❑ FHA/VA: Y— rI No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept Tank.- Distance from nearest we•.L-Ste..-----Distance rfrom foundation..- . l.L.......Matenal. ........-. No, of compartments _.. .....Size:34vI.f-57' Liquid depth.—TO"A.-. . Capacity.. `G'... Disposal Field: Distance from nearest well (pQ�._.Distance from foundation.....2 Distance to nearest lot line-45.�....... (� Number of lines......(-'?5��--p....... .Length of each line.-- .... Width of trench"1 i4.._.... }C Type of filter material � ..O�riC�(LDepth of filter material....---.-/.8-..-Total length............ _ Seepage Pit: Disiance to nearest well.... ..............Distance from foundation............_.......Distance to nearest lot line. ----- ❑ Number of pits.___....__.-..Lining material............ ....... .Size: Diameter------------- ..... Depth _.. Cesspool: Distance from nearest well................Distance from foundation Lining material......_ ............................ (_l Size: Diameter-........... .. .. .. . —...Depth. ....... ... ............... ......-.. ._.._Liquid Capacity. . .....................gals. Privy: Distance from neo-est well.. _- Distant: from nearest building. ❑ Distance to nearest lot line Remodeling and/or repairing (describe):.. Gf . -�7 _ .. -_-- ---.... -- ... _ . .. . . I hereby certify thaf rn a prep ed t •; application and that the work will be done in accordance with Sar. Joaquin County ordinances, State lswz, an ' rules reg ations o San Joaquin Local Healt:'- District. (Signed)..- _...... .......��C � L� .` -'. . ........ .. .-Owner and/or Contractor) y:. ......................... . ..... /..(Title)....... (Plot plan, showing size of 100ocation of system in relation to wets, 2ldings, etc., can be placloin reverse side). FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED BY. . /'l<<„c r f _ . , • G.-.-_-�. . ........ ........ ... .... .. .... . DATE._ '..::..%..-.... ..:....... _............. . REVIEWEDBY_......................_......----.. ----- .... . DATE. ... .................. ........... .................-. BUILDING PERMIT ISSUED............................. .. . .... ..... ....... ................ ---- DATE..... .... ...... ...... Alterations and/or recommendations:......... ..__ _ -. _ .......... -_.....__. _ -----------------------........ .. .... _.. . ...... ... ..... .. FINIAL INS'ECTIOtJ BY Yf ty'� 1� //y- Da' v/ SAN JOAQUIN LOCAL HEALTH DISTRIC-i 130 South Amer{cen Street 300 Wert Oei $tree} 172 Sycamore $free} 814 North •'C- Straef Sfociton, Cali(orni• Lod:, CoMornie Menteca, California Lecy, California —9—IM Re.;no :.57 F :rn