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Ad j 3 APPLICATION FOR SANITATION PERMIT �(I S [Complete in Q�•cate]; Ap ieation is hereby ade to the San Joaquin Local,Health District for a permit to construct and install f}(e This appiication'Js made..in.compliance.with County Orclitiance•No. 549.,—, - .- herein d scribe . I JOB ADDRESS'AND LOCATION_ 445/ � � --------------------#------------ � ---------)_ --- ----------/,''/ '!`_t� " _ � --•------ ------------------------------ Address ----------------------------- Owner's Name-�-------�C'o'�9' - _ Phone-----L_.___•�_ --~- --- y Address____..` , Contractor's Name--------____---------______ I, -- ------------------------- -------- -----------------�-------�---------- - -- Phone-_11, hone- --�.---------------------•------ i Installation will serve: Residence, Apartment Hose Commercial i ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number ofliving units:-❑ Number of bedrooms ® Number of baths 0 Lot size___ � k Wafer Supply: Public system E] Community system [E] Private I Character a'fsg4jo-a6depth of 3 feet: Sand �,., f 3 ❑ ra.vel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe UK*Hardpan El TYPE OF INSTALLATION AND SPECIFICATIONS: y (No septic tank or cesspool permitted Cif public sewer is.available within 200 feet.)! Septic ank: 1 �j ��D�tance from nearest well____'1�:_�__-Distance fro undation____.��_.�__.___.Material_v---___- - �- No+�tpf compartments c r J ------ - .. p �'-r--,-+��c.�rC,.,�p�,city�----- - -----------Size.��_�-x--g---------Liquid depth------- I�---�------ Cesspool: Distance from nearest well_________________Distance from foundation----------- 11, r --�- I u p - ---------------------------- Lining material_ ----------- Diameter-------------------`------•,�...-�.De �:�-----• - --- -- - � ❑ cPrivy: ce from nearest well__________________________________ Distance from nearest building e to nearest lot line---------- -------------------------------------- Seepage ----------------------------------- See a e Pit: � � � � ❑p g I Distance to nearest well______________________Distance from foundation-----------_______.Distance to nearest dot line___________-___-- Number of Pits----------------------Lining material_--__-____- p Size: Diameter ---De th---=l---------- �'.Disposal�Field: Distance from nearest well____ . '__-Distance from foundation___�01(__---Distance to nearest lot lin____�--Q__ J-.r...-...._,....,.—rte ,X. Number of lines _ ILength of each line--------l�_L__��---_-Width of trench--___e _. -� i 1+ Type of filter material -___'____-_-__Depth of filter material_______)_f_f i _ Remodeling and/or repairing (describe)------------------------- ---------------------•---------------------- ----------------------------- I� --------------------------------- --------------------- -----------------------------------------------------------------------------•----------------- ----------------------------•------------- ------------------------- I hereby certify that I have prepared this application and that the work will be don in accordance with San Joaquin County- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, i (Signed) r ,� ,{ 1 {Owner and/or fir] BY: --------------- ---- ------------- ---- - -- --____--Title (Plot plans, showing size of lot,location of system in relation to wells, buildings; efc., must be fled with this application). d _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____________ �- ' `DATE-______-_ I ¢ - - REVIEWED BY ------------------- - ^,-.,,: -- _' DATE =-=------ BUILDING PERMIT ISSUED________ ___Q - ___-___.____ DATE - 1` ----------- Alterations and/or recommendations: ---- I�. -- --------------------------- -------------------------------_________________ Y / _Q' -------------•------/------_ _ -_ _ Y� KT __-------------------------- ------- ________________________________________________I�_______________--_______ _______ ___ __________ _____ ________-________---__--____--___________-____.___.-----------.----------------------------- --------------.____._______ , PERMIT N21-F-7----- ISSUED-`S_�__ Y__ ----'Date] FINAL INSPECTION BY:----------1�" / = ` a . . - Date--------------------�- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef E5-9-2M 9-50 W-1639 Sfockton, California - d