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----------------------------- --- ---------- APPLICATION FOR SANITATION PERMIT Permit No. .. --.-- __ - (Complete in Duplicate} Date Issued -------------- ------- ------------ -------------- This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Health District for a_permit to construct and install the wk herein e�scjr�ed� This application is made in compliance with County Ordi lance No. S4933 . � f JOB ADDRESS AND OCATION_ +��-_- - (- ---- `'C � !i Owner's Name------- --I: -= --=�-------- 1_i/--� �- ------- ------------------------------------ Phone_ Address---=--------------- --=- ---------------------- Contractor's Name 1 "12�C - Phone - / Installation will serve: Residence I��partmeO House ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ ___ Number of bedrooms _3 Number of bafhs _C� Number of living units: Lot size ____ ---- --------------- -------- ` Water Supply: Public system ❑ "Community system [I Private �epth to Water Table ft. T el San Loam Clay Loam ❑ Clay ❑ .Adobe C Hardpan ❑� Character of sail.#o a depth of 3 feet: Sand ❑ Gravel ❑�y ❑ Y F,, Previous Application Mado: {If yes,date.....................) No New Construc#ion: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permittedif public sewer is available within 200 feet.) ank; Distance from nearest well---.-_______--_Distance from foundation--__-._____-----.-.Material.------.--__---.___________-__________________ Ca acit - No.-of compartments----------------- - --Size------�- ---------------- �_Liquid_depth------------ ------- P Y-------------�-,------ I -/-- , 5 � _____.Distance to nearest lot line_5___-----_- Disposal Field: Distance from nearest well___.__---.._-_-_Distance from foundation_________F f, { ❑� Number of lines----------- -. _---_/ Length of each line-/-a 6___f ___.Width of trench._...,- _---------------- Type of filter material____ '_I- �CDEpth of f Eter material--_/ _________Total leng#h..._,fes_ _------------------ _____ f Seepage Pit: Distance to nearest well-------_--------------Distance from foundation--------------------Distance to nearest lot line--__----__-_--___ ❑ Number of pits----------------------Lining material-----. ----------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest we.11------------------Distance from foundation-------------------_Lining material----._--_._-_----.___-_--_--_____.._. Size: Diameter ---- -- ---.Depth--------------------------------------------------Liquid Capacity----------------- 9a � ❑ - ,' ,. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- Distance ___________________.---------- Distanceto nearestlotline----- ------------------- ------- ---------- - ---------------------- -------------------------------------------------- ----- Remodeling and/cr repairing.(describe) -------------------------------------------------------- ---------------------------- ---------------------------------------- ---------- - f , ---- ---------------------------------------------------------------------------------------------------------------------------- ---------------------- - - = ---------------------------- --------- ---------------------------------------------------------------------- --------------------------------------------------- _. .. I hereby. certify that I have prepared this application and thaf the work will be.done in accordance with San Joaquin County ordinances, St laws, and rules and reg tions of the,San J quin Local Health District. (Signed)__ ,er and/or Contractor) -- --- - _ .-- - - ---- -----_---------:----------------------- - ----(o _ {Title) Lam------------------- --- By:------------------------------------------- ------------ r.-__,.. ------------- (Piot plan, showing size of lot_, location of system in relafion we Is, buildings; etc.; .tan be placed on reverse side}. FOR DEPARTMENT USE ONLY { � - r , ; � E �----------_---_--- REV.IEWED..BY-------------------------- -------------------------- ---------------------- ry �= APPLICATION ACCEPTED BY------------- ---------------------------- -- ------ ----- ---- BUILDING PERMIT ISSUED---------------- ---------=---------- ----------------.;%-t�--- - ,� --------- ,-, ------ Altera#ions and/or recommendations: f a �= - ---------------- ------------ - i k --_--- ------------------ ---------------------------------- -•------------------------- -----------'-----=------------- --------------------- - ----------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ----------------------------------------- - Fi ----------------------------------- ---------- -- - --------------- --- -- -------------------------- L Q- FINAL INSPECTION BY-------------------- -------- --- - --- Date---- = ------------ - F1SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street