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APPLICATION FOR -SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County 0,erdinanc,l), No. 549. <br /> JOB ADDRESS A LOCATION <br /> 4- ----- ---------- ------------------------------------------------------------------------------------------------------------- <br /> Owner's Name... -- -- -- ------ -------------------------------------- -------------------------- <br /> Address----___ -___ <br /> Contractor's N m ---------------------- - --- - ----------------------------------- ----------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House Ej Commercial E] Trailer Court F] , Yofel El Other El <br /> Number"of living units: Number of bedrooms 3 Number 0 r baths Lot size------7Y_01_1�--------------------------- <br /> Water Supply: Public system E] Community system E] _Private <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F-l Sandy Loam [] Clay Loam El Clay E] Adobe M/Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fe + <br /> Septic ank: Distance from nearest well <br /> - - -- ---Distancef f dation___ --- Mat <br /> ial- ------- <br /> IL <br /> No. of compartments--------- ------- ---------Capacity, Size- - -- <br /> - -- lquid depth____--____ ____..______._ <br /> I _T 0---1 7 <br /> 'Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_---___-_- ______---._ ---------- <br /> 7 <br /> El Size; Diameter---------------------------------------Depth---------------------------------------- <br /> 'Privy: Distance from nearest well-----------------;-------------------------------Distance from nearest building <br /> -1 ------------------------------------------ <br /> --------------------------------- <br /> F Distance to nearest lot line-_________----'_______________ <br /> I <br /> Seepage Pit. Distance to nearest well---------------------J--Distance from foundation-------------------Distance to nearest lot line---------------- <br /> ❑ Number of pits----------------------Li 'ing material-----------------------Size: Dia ' te' <br /> e er------------------------Depth--------------------------------- <br /> Dis P_6s Field: Distance from nearest well---- Distance from foundation-_____ to nearest I line------ <br /> !Length of each line--------1__X ____.Wid+h of trench------- -%--------------------- <br /> Number of lines__-_-_____e---- --------- ---I <br /> Type of filter materiaLip__ __._ ---------'Depth of filter material----------- <br /> aterial----------------------- <br /> f <br /> Remodelingand/or repairing (describe)--------------------------- ------------------------------I------------------------------------------------------------------------------------------- <br /> k ---------------- ---------------------­-­­------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------•T---------------------------------------------------I-------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------- -------- ------0----------------------------------------------------i I <br /> ---------------------------------- --------------------------------------- <br /> -4tk) <br /> I hereby cerfi y that I have prepared this application and that.the work will 6e'done in accordance with San Joaquin.Counfy <br /> ordinances,, Sf tte�ll ws, and rules and' regulations of the San Joaquin Local Health District. <br /> [Signed}----, <br /> ----- ---------------------- ----------------------------------------------------------(Owner and/or Contractor) <br /> By:-------------------- ------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing size1-0-c-,; <br /> pf 10 ion of system in relation to wells, buildings, etc., must be filed with this application). <br /> ,7 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> -------------------------------- - -------------------------------- (DATE _7?P <br /> - - <br /> REVIEWED BY- Y ---- -------- ------ <br /> ------------------------------------------ DATE <br /> BUILDING PERMIT ISSUED -------------- ---- <br /> L <br /> t <br /> -------------------------------------------- DATE <br /> AferZon, orlrecomln0 afionk:____ <br /> - - ----- - -- ----------- <br /> ------- ----------------------------- <br /> -------------- <br /> r --__. <br /> ---------------- <br /> ;wai- --- - ------Z <br /> c-A jgea <br /> —1b <br /> PERMIT Noi�... Jl__�� ISSUED ------- ------ --- ---------(Da INSPECTIbN BY: <br /> A, <br /> Date-------------------- ----------------- ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> IV <br /> ES-9-2M 9-50-,W-1639 <br /> Al wg',t <br />