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Zi APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued `Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. t This application is made in compliance with County Ordin e No. 5 JOB ADDRESS AND LOCATION--- ------------------ '' �C � 1 Owner's Name % % "1-----� -----• - Phone ---' Address------ std ---- ------------------ . ! ,, Contractor's Name.v = --t. ,=�-- 4ti Phoncf Installation will serve: Residence d_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-__ Number of bedrooms.Number of baths /----- Lot size __ _Q.____,I�___L___ ___ ______________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table&0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe an Previous Application Made: Yes ❑ No —idew Construction: Yes ❑ No TYPEOF INSTALLATION AND SPECIFICATIONS: S' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic.Tark: Distance from nearest well.,lll.o-llR -Distance from foundation_-_J_�_.-_-_ Material---- �' x% No: of compartments------------.�.�__.__-__ -Size____-_rte�Q l�_ .__Liquid depth......... Capacity-._y5-a-0 - ispo sal Field: Distance from nearest well.................Distance from foundation----------..........Distance to nearest lot line---------------- Number of lines-----------------------------------Length of each line------------------------------Width of french.---------------------------------- �" Type of filter material--------------- ---- -Depth of filter material-----------------------Total length.--.---.-_-_-_---_._____-_-_________-_-.._ v; Seepage Pit: Distance to nearest wel3,cL.____--Distance rom foY ndation___!- ..___Distance to nearest lot line-__-le._ -_ Number of pits------- ------------=Lining material, lLs ;-- e: Diameter-` ---.'- Depth_ .��.-'------------------- --------- Distance from nearest well ______.--------Distance from foundation—.----__.------.Lining material------------------- - ---- ---•- ❑ Size: Diameter ------------------ ------------- Depth------------ --I----------- ' - ------ �° ` `---_Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well------------------_------------------------------Distance fromf'nearest building------------------------------------------ ElDistance to nearest lot line-------- --------------------•------------------------------------------•------------------------------------------------------------ .- '' Remodeling and/or repairing (describe: ` r ------ ._... ----------------------------------- --------------------------------------------------------1_--�--=--- ------- -- -e --------------------------------------------------------------------------------- -------------------- ------ - - ----------- ------=--------------------------------------•------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5 ate 1 ws, and ules and regulations of the San Joaquin Local Health District. , ---cam. (Signed].__ _-...____(H)wtfer�aadoF-Contractor) '�/ 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.--- --------------------------- DATE-- --=------------------------------- REVIEWED BY ----- DATE_�r ---------------------- BUILDING PERMIT ISSUED DATE------------------------------------------------------------- IU� ---- ---------------- -------------------------------------------•---- --Alterations and/or recommendations---- -------------------------- ------ ----------------------------------------•-•----------•-----------------•-----.-----•---•----------•-----------------._.. ---•-•------------------------------------------------•---------------------------- ------ --- ---------------------------------- ----------- --•--------- --- -- -- t ---------------------................ FINAL INSPECTION BY:. - - ----- -------- Date----�