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APPLICATION FOR SANITATION PERMIT Permit No. sa?/_.1_' Z <br /> (Complete in Duplicate) <br /> . Date Issued <br /> " Applica+ion is hereby made to the San[Joaquin Local Health District for a permit to construct and install the work hereiri described. <br /> This application is made in compliance with County Ordin e 549. <br /> JOBADDRESS AND CATION--------- ----��--- ------ - ------------•-------------------------------------------------------------------- <br /> r <br /> Owner's Nam °' d, - -•- --- Phone ## <br /> -------- = �-- <br /> Addres ----------------- - ---------- ._ -_ - ---------------------..._.----•------------------- T 4' <br /> ,__7�Zk <br /> Contractor's ame____________________' <br /> -� -- ----------------------------------------------: Phone--- <br /> Installation will serve: Residen e Apartment H ❑ Commercial ❑ Trailer,Court ❑ Motel ❑ Other ❑ <br /> Number'of living units: Number of bedrooms _ Number of baths _: Lot size ____,f _ __ !- `' - ----------------- 2 <br /> Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table04Z_'50*ft. <br /> fi <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction Yes No ❑ ; <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta k: Distance from nearest well................. from foundation--------------------Material_____-.__--_.____________,___________----_-___. <br /> ���/// <br /> �.r No. of compartments------------------ ------Size---------------=------------.---Liquid depth--------------------------Capacity--••------------------- <br /> Disposal Fiel : Distance from nearest wed____ .`d.__Distance from foundation___ .�__ __.Distance to nearest lot line_�Sl ,P�l <br /> .► � ate. <br /> .Number of lines___________________________ Lehgth of each line___«1Q___--- .Width of trench_._________ <br /> F �' Ij( - ---�-----Tota I length or' filter material_��___s._._____ aDepth of {filter matenal_______.�: g <br /> . . <br /> Seepage Pit: Distance to nearest well---- --------------Distance f om fo dation� :_____._.__.Dist afce to nearest lot line _______ <br /> - Number of pits.____/_._______ Lining material_ tet ► Size: Diameter____ <br /> ---- - ,7-------------.Depth- ---� ------------- _ <br /> Cesspool: .. Distance om nearest well -.._-Distance from foundation--------------------Lining material--------------------------------------- <br /> 'o <br /> ,____ _ __. __ <br /> ❑ . Size: Diame er----------------------- Death-------------------------------------- Ligaid'Ca a6 als`. <br /> P tY - g <br /> Privy: Distance fromNearest well ----------------- ._______Distance from nearest building----------------------------------------- <br /> El <br /> ___ _.___.__ _______._❑ Distance to nearlst lot line-------------------------- ---------- --+- --- ---------=---------:------ ----------------- a------_-- ------- -- ------------ <br /> .e --Remodeling and or -- _ <br /> _ _ <br /> --- ------------------------- ---------- ------ ---------- - <br /> /� --------� - - ---. ir <br /> --- ------- - - � f <br /> ercer itha h e a is application"a � f : w m accordan w�i n m oun� <br /> o finances, Stat ws and rules nd regulations of the San oaqui oca! Health District. <br /> (Signed) - x ��' ;F --'_---'--------------------- --------------------------------------------------- - <br /> Owner and r Contractor) <br /> By:----------•- -----•- = ------------------------------------•--------------------------------------------(Title -���------- ------ <br /> (Plot plan, showing size lot, Iota ion of system in relation to wells, buildings, etc., can be d on reverse side <br /> a FOR DEPARTMENT USE ONLY r; <br /> APPLICATION ACCEPTED BY ----- ------- -----------------=----------------- DATE-: - <br /> REVIEWED 'BY _'_-------------------- -------------------------------------------------------------------------- ----- DATE------ ------- <br /> BUILDING PERMIT ISSUED - --------.---- .�_ *D`ATE "'a. <br /> Alterations and/or recommendation :--.---___ -- i --- -- .--------:__ ,_�--_---------� -- _ -- ------------ <br /> --------------------------------------- <br /> ----------- <br /> ------------------------------------- - _----- - ------- _ ------- <br /> , , <br /> - -----------------------------------=- -------------- ••------ --- --------------- <br /> ------------------------------------- <br /> --------- ------------------------------------------------------------------------------------- ---- <br /> f <br /> ____________________________ __________________________________________ __________________-___.}-.-.- <br /> f////ff�' <br /> FINAL INSPECTION BY:- - -- T = —=-- <br />