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S <br /> Pa„r,;tt No. y <br /> APPLICATION FOR SANITATION PERMIT <br /> �`�\ (callpleb in Dapl 0011011 <br /> Appheasion is heroby mads to 4he San Joaquin Local Haalth District far a permit to tonstrvtt and instal the w04 herein daeenlwd. <br /> This application is made in compliance with County No.549. <br /> . D T ... <br /> JOB ADDRESS AND t.00ATION........ <br /> �Za 7 <br /> Owner's Nane........ <br /> Addrwss.......»......»....�. ...� . . <br /> Contractor'; Name.. „��-»..._..... ...................».. ....».......�Plhoe�a/x'JP.A.»-..,(..�d.,,7 <br /> ..._.. ...... .. ....... »»......».._......._. :.. ...»..»...» <br /> Insolation wll serve: Residence &10Apa1tment House❑ CommotcW ❑ Traiwr Covet ❑ MOW ❑ Other ❑ <br /> Number of living units:..rl... Nurnt:er of Mdroans..J'..Number of betbs 1- Lot size. .�.. '- »» <br /> Water Supply: Public system [y�Community system ❑ Private(Depth to Water Table . lit it. <br /> CBt.rae*r of sal+..depth as 3 fest: Sand Growl❑ Sandy loom❑ clay barn❑ CIaY❑ Adobe�Hardpat❑ <br /> F wiooe A lka#Ion Made: Yes❑ No( New CorKtractian:..V No <br /> PEOF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted IF t J&nwel <br /> Septic T nk: Distance from nearest well...»...» . O'ntance from foundetbn..:_.........»...Material..........................=.............. <br /> �No. of compartments..... _ ..5'Sze...,......._»«..... .......Liid d.Rfti•» Capeaty- _.....» <br /> Disposal Field. Distance from nearest well ,Oistence'from foundstionr--..»- .. -.D�stance to nearest bt <br /> ❑tr Numl"- of lines........... . ...»;....._Width of <br /> Type of filter material.. » oth aF •��Tom '" » `t" W <br /> Seepag Pit: Distance to nearest well. 9_ .D` Cf ��nce to nearest lot I�_AV»» Q <br /> Number of pits..... ......... inrng� ..Sipa: Depth.... <br /> Cesspool: Distance from nearest well....»." Distance fromfewndatwn... lMmg material.-_.µ .»..-»..-•- <br /> ❑ Size: Diameter... ........ »... »»... --Liqu d Cepacity... .»- •-9411 <br /> pr;�,y; Distance from nearest wee from nearest buiklMg.._. <br /> ❑ Distance to neatest lot fine.... <br /> Remodeling and/or repairing (describe):...... .. <br /> .........«...............»».........».».. ............»...».......»..».........._....«.»...�..... »-» ..._........»- too <br /> .._.....».......»...............................».._......_......_._.._»».......-»»-..-•. <br /> »� herby e�►hfp that I have+prepared this.ppRe.Non and that#a work wo be done in accordance with San J00-wi• CON* <br /> ordinances, State and rules and regula of the San Joaquin Load Heo tb Dist". <br /> ,,, . �eit'�.rtC.�x«........ (illr and/or Coatraeterj <br /> (5ignedBY:. .............._ . . ... ... ............ <br /> (Phot plan,showing ince of lot,bcation of system in rtlati0n to wak buildings,ete.,can be placed on rows salol. , <br /> FOR DEPARTMENT USE ONLY <br /> mom <br /> APPLICATION ACCEPTED BY........................ .� a» DATE..-........... --- <br /> REVIEWED BY................................................ ...... ... .77 <br /> .. DATE.— _.....»-•.» ........«..._.• r ; <br /> BUILDING PERMIT ISSUED..._........................ ......... ».»... »»DATE:,»....... ....»...».:.._......, <br /> Alterations and/orrecommendations..................."» ».»».. ..--•.»..».«-. ....'.- "'".."'" .""".."""........ <br /> ....................................................................... .......» .. ....» »...».....»......». ..».,.... ..._«......... <br /> ................................................................................... .... ..�.."......... . »... ...... .............»....:« _ Ye ` <br /> ....... .. ».». 4 a <br /> f <br /> FINIAL INSPECTION BY:............. ... » <br /> SAN`JOAQUIN LOCAL HEALTH DISTRICT <br /> 11!Sywwa+fMe► 814 NaN"C"sheN <br /> 120 South Amedoon Strout 200 Wss1 Od Slrfaot T GMbrats <br /> SteekMn, Ghieroto 1OKC&IIPWJ& <br /> MM11eM,C'r�MMM . <br /> 5--9-2101 Rovi,od W-2100 <br />