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f UK UN-K-L LRIL: ' APPLICATION FOR SANITATION PERMIT Permit Na. .___�_7J��--.- "4 ---------------------- --------------------------------------------------------- (Complete in Duplicate) �y p Date issued -------------------_....................._ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th r herein des n ed. This application is made in compliance with County Ordinance No. 549. l � lr__ JOB ADDRESS AND LOCATIONS4&_ _ l r / ------- �_,/:n AZ ------------- Owner's Name---- - ---�� --------------- ------------ -------------------- -- --------- Phone-------------------- ------------ - Address------- {' ,! -------------------------------------------------------------------------------------------------------------------- Contractor's Name--------- r -� Phone ------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _- Number of bedrooms._ Number of baths /._ Lot size la-°oO"_ _________________________________ � +� Water Supply: Public system ❑ Community system Ll Private 0,<epth to Water Table frf. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No V;r� New Construction: Yes jre"'No ❑ FHA/VA: Yes 4- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: h (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta : Disfance from nearesf w II� --Distance �f�rom f u dation_! ______.Mattal_ - x _ / - No. of com artments,�____..______ �5� � p size. quid depth---- -- ---- --Capacity Disposal Field: Distance from nearest well O_____.Distance from foundat-ons 2�__ __--Distance to nearest loot line_ _____.__- 9 r Number of lines__ _Length of each line_ j _______ ___________Width of trench _ ----------- Type of filter material � � Depth of filter material_ __ _______Total length__. ___ f -=----------------------- Seepage Pit: Distance to nearest well----------------------Distance from, foundation-------------------.Distance to nearest lot line----------------- El -_._-- __---__❑ Number of pits----------------------Lining material---------- ---_-_---_.Size: Diameter-----------------------,Depth_-------------------------------- i Cesspool: Distance from nearest well-----------------Distance from foundation--------------_-----Lining material___________.___________________- ' ❑ Size: Diameter_---- ----- ---------------------- Depth----------------------------------------------------Liquid Capacity------------------------ gals. Privy: Distanca'from26Zaresf well-------------------------------------------------Distance from nearest building---------------------------------------:-- ❑ Distance to nearest lot line---------------------- ---------------------- ------------------------ --- --------------------------------------------------------- Remodeling and/or repairing (describe):----- - 9' t --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. y (Signed)------------------------ Y - --------- --- Contractor) - ------- - - ---- i BY:----------------------------------------------------------------:---.. ------- -- (Title}-- -="---------- - - ------------- (Plot plat,, showing size of lot, location of system in relatio wells, buildings, etc., can be pl ced on reverse side). FORD ARTMENT USE ONLY I r APPLICATION ACCEPTED BY------ ----------------------- ----------- ------------------------------- DATE--- - ATE-- f ------------------------------- REVIEWEDBY----------------------------------- ------------------------------------- --- ------------------ = -- DATE- ,� ------------ BUILDINGPERMIT ISSUED--------------------------------------------------------" ---------------------- - '---- DATE------------------------------------------------------------ Alterationsand/or recommendations:--------------------=------------ -- -- ----- --------------------------------------------------------------------------------------------------------------- --------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- --- -------------------------- ---- -------------- --- ----------------------------------------- A FINAL fNSPECTION BY:-------- :- - - - SAN-JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street