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_...................................................• .,1 ...................................................... APPLICATION FOR SANITATION PERMIT Permit No. _. . .... ....................................................... (Complete In Duplicate) // ...............................................••. • Date Issued !'� . 1.1. ' This Permit Expires 1 Year From Date Issued _ Application is hereby mode to the Sen Joaquin Local Health District for a permit to construct all e work herein descrbed. This application is made in compliance with County Ordinance No. 549. 1 JOB ADDRESS AND LOC��ATIO�1.. . 1 }I !-_F'.._..._.._..? t':�.... .t i 1.`...:_'..- i �� ' I Owner's Name..................-�-_-.!jq 1 C r ......... I!.11lA Ttp �._.. 1 .......�....��:.t..._!��......_ T7............. ,77 _ ' .� Phone.. Address.............fh�.:��...-.._..(/.!+�.....��y..l,':<,�-�-',�� T/=_.:........1.��c:---�� :r.1.......�.T'.�a.f.'.. •_ � -.....---�-.................. ,. ......, ,l Contractor's Neme..._��,/.��i,�=.f1,•„--_____•_.--.•.. _,. ............................................................................................. Phone........__......... tnstallation will serve: Residence 0Apartment House ❑ Commercial ❑ Treile Motel ❑ Other ❑ Number of living units: ..J.... Number of bedrooms � � ,.. .. Number of baths .,!.- Lot size ..... � .: >' i Water Supply: Public system E] Community s stem E) Private KI/ Depth to Water Table .6". .,. Character of soil to a depth of 3 feet: Sand Grovel ❑ Sandy Loam❑ Clay Loam [] Clay ❑ Adobe❑ Hardpan Previous Application Mede: (If yes,date...... ❑ ••-••) No ©� New Construction: Yes El No ❑ FNA/VA: Yes ❑�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: `e. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ifQ}��FA[3 Septic Task: & Distance from nearest well..... .0%....Distance from foundation-_../ . ....._..Meteriel_..�:. No, of compertments.......�.. ' ' ---•-_...Size..�.3') ..:�....�.......Liquid depth....� ...............- --..Capacity... .................. Disposal Fields Distance from nearest wall... ,(.,�• •Distance from foundation....-U. ........Distance to nearest lot line....`,p ...... Number of lines....... ........ -• ngth of each line.. {' �.-(t ' Width of trench....t�-' 'r Type of filter material---L�la�„ ---•• ...De th o filter mater,al----•I%...........Total length...............j.: f.?._..._........ Seepage Pit:. Distance to nearest w Dista from foundation..•--......••-..-.. • _,• Distance to nearest lot line................. `i ❑ ,Number of pits....----_- Lining materia.. ............ ......Size: Diameter............. '--...---Depth.............. ...••-•. ......... ..0 Cesspool: Distance from nearest ll................ Dista ce om foundation....................Lining material.._......_..............__........... l ❑ S Diem . ..................Depth.............................. .....................Liquid Capacity..... gals. Privy: Distance f om Barest we Distance from nearest buildin ❑ Distance t n rest lot lino............. .... g Remodeling end/o repairing (describe):...........�!t!T :.---.. HLA..IIC. ...1._.(�, .---.Q./V..._ jf1 C p ................................... ......................................... 0. ---•------•••• -- . . , . ....... .. ............................................................................................................................. .................................----••-----•'••--.................. ............. I horeb�'y certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin. County ordinances, State laws, and rules and regulations of the San Joaquin Local Hoelth District. /,. (Signed)........ l�•�� r� c:l� .,/..�, 7 ( / •--•-- ' •'--•• .......... Owner and/or Cd ontractor) By:...:..... ..........,._.......--........................ . Title _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE-ONLY — - - • APPLICATION ACCEPTED BY...... _t...1 ..1..c DATE REVIEWEDBY...................................•-•. . . ... •• ..••. .."�-........•.... .....•....... DATE...... ..... .... .... . BUILDING PERMIT ISSUED ..........................•- •- - - - .. .................. •--'-•----------•_...... .................... ........ DATE..........--•--• A terations and/or recommendations:........ ................................................................................................................................••--•--•--•-••-••..... ............................ ... ....... -z ::_ ._....'pIN K ��/ 7A •� o t CoM.L' ��_.. S ..i�tv�C�.1cT=_1�_f ntR._�NN:�... :r=...•-•---T.1R-0............................................................ FINAL INSPECTtQ t�BY:.., .. ...... .... . ... Date.. ....-�....�..�..:._�...... ... .. .. ...... . • - ------•----•--'- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Massillon Ave. 700 Wed Oak Street ' 124 Sycamore Street ?OS West 9th:tresis Slocklon,California lodl,California Montoca,California Trocr,CalHomlo Ci a nCVIYCD D•ba 7K 3•'63 F.P.CD.