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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued f�-r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Cou y Ordinance No. 549. , I AND&CATION---F----_I ------------- ----------- JOB ADDRESS AND - -- -------- ku kyU Ordinance rice -------- -- 0------ ----- ----------------------------------------------- -0--- --- ----- ----- Owner's Name----- ------ -- ---------- ---------------------- --------------- *fj -------------*-------- ne-----------------F - ------------------ ----------------------------------------------------------------- --------------- Address-------------------------------- ......k-1---- ------ -----f-4. Contractor's Name------------------------------------------ ---- ------------------------------- -------- --------- - -- ----------------- Phone------- ----------------- Installation will serve: Reside Xel Apartment se C V) Fcial [-] C rt, Motel ❑ Other ❑ H m *V4om er baths Coy .I of ❑ ot —---------------- Number of living _,2umber of be roo umber of ba hs o size nb Water Supply. Public system El Community system E] "Private)� Depth to W?fer Table JAOft. Character of soil to a depth of 3 feet: Sand [-] Gravel [] Sandy Loam E] Clay Loam [] Clay E] Adobe)( Hardpan E Previous Application Made: Yes Fj No New Construction: Yes No Ll TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sew2r.i available within 200 feet.) - - --------- Se fic Tank: Distance from nearest well PtWX?_1Mstarjce fa k1afion------ D------Materipa - ------- pa6 yJ No. of compartments----------- Su'z e -- ----Liquid depth-------- __,*Capacity_.#jM0_Q'! lot ---- ------ Zkf� ance from fou: ;2__ - isfan to nearest lot ling-__ _.__. Disposal Field: Distance from nearf well 9dafion___j__ A ---. - --- - -WtFM Number of lines____________ ----------Length of each line_V—&f.-1", j french---j__0------------- 17 K Type of filter mater i of filter material-------11---------Total length____.-..__' -�-- j C Seepage ength--------- Seepage Pit: Distance to nearest well----------------------Distonce from foundation--------------------Distance to nearest lot fine--.__---__-_____ i ❑ Number ine---------------- Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------_---Distance from foundation-------------------Lining material-------_----_______________.____, � ❑ Size: aterial----------------------------------- Si7e: Diameter------------------ -------------------Depth----------------------------------------------------Liquid Capacity----------------------------gal Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or airing.(describe}:_(_ --- ------- re �q C " 'C-- ------- --- -------------------------------------------------------------------------------------- --------------------------------------------------------------•------------------------------------------------------•----------- ----------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----4 -- ---- ---- ---------------------------------------------------------------------(Owner and/or Contractor) --------------------------------------------------- ifle)------------------- -------------------------------------------- BY--------------------------------------------------------- --------------- ------(T* I (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--------------------------- --------- ----- - -- ----- --------------------------------------- DATE------- -- --------------- -- ........`• )i------- - DATE-- ---- ---------------------- ------- REVIEWED BY------------------------------------------------------ -- ------- --- ----- ----- - --------------------------- ---------------- - ------------------------------------------------- BUILDING PERMIT ISSUED------------------------------ ---- _------------ 4 Alterations and/or recom ndati"s- ------- .............X-1------------------"Z----------e---------- ------- ----- -------- -------------- -- --- - --- - --- -----• ---------�;t�------------ - -------- ------------------- ------------------ ---------Z, -------- ----- -- --------------------------- ----------------------------- -------------- --------- -------- --------------------------------- ------------------------------------ --------------- --------------------------------------------------------------------------------- ----------------------------------------- FINALINSPE I N BY--------------- ... ... Date---- ---------------------------------- --------------------------- OA<&I l-�L HEAL L t W., JPS�o.JhnArmn�.rican Street 300 West Oak Street Im SycaWrmn*ZSfTrra6f a rfh "C" Street Tr Orr 1711c�� South ro�r" , , a ma Sto kt , C 1i k E 9 7 . S-9— _