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rvrc urrIk-C ux: <br /> APPLICATION FOR SANITATION PERMIT Permit No. -� -1--��-�--- <br /> --------------------------------------- (Complete,in-Duplicate) <br /> Date Issued <br /> ------------ ------- This Permit Expire" 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin_Locai Health District for a permit-to construct and install the work herein described. <br /> This-application is made in compliance with County Ordinance No. 549- <br /> JOB ADDRE55.AND LOCATION---4-/-- j ��`� ----- Fri. { -4 ° fr - .- <br /> �- Owner's Neme - ' ` '� ----- ----------------------------------- ------ --- -=- ------------ - ------------------- Phone <br /> Address-------------4-2- ---�-�_ ---- �-----r------------I - € ------ -- , <br /> 1------------------------------------------------------ <br /> _ <br /> Phone x= -T. <br /> i Contractors Name.. ---`--------------- <br /> i — - <br /> Installation will serve: Residence X Apartment House ❑ Commercial -❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of bedrooms Number of baths.-1-_-_ Lot size -.__vtf '_``= = ------------------- <br /> Fri <br /> Number of living units: -_j-- '2'- <br /> Water 5u I Public s stem Communif system Private Depth to Water Table 1 t u <br /> Supply: Y ❑ : Y Y ❑ `� P <br /> Character of soil to a depth of 3 feet- - Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam K Clay ❑ Adobe I] Hardpan ❑ <br /> Previous Application Made: {If yes,date........ J No New Construction:-Yes ❑ No FHA/VA: Yes ❑ NoX <br /> u �. <br /> TYPE OF'INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well------------------Distance from foundation___-----------------Material------------------------------------------- ----. <br /> ❑ � ? No. of compartments----------- --------- ---Size-------------- _ Liquid depth - Capacity <br /> Q.isposal Field: Distance from nearest well t.-!_------Distance from foundation-- -_---------Distance to nearest lot line.--S <br /> . F�------------------- <br /> Number—of - - <br /> L 6 lines:-- fes- '- ---------Length of each line---- -- --- - -------Width of trench : ---Type of-filter_material-- fs�4 ---.--Depth of filter mater.ial_-__1- -=----------Total length-__-_ _ :---_--_--_---_-_------- t <br /> - .--Distance from foundation--__-- f -- r <br /> Seepage Pit: Distance to nearest well -- ____-- - -__._.---.D stance to nearest lot line _ _--_ <br /> EZ Number of pits._ F_r Lining material OG' _- Size: Diameter--- ------Depth- ± ! - <br /> Cesspool: Distance from nearest weU --------Distance from foundation------------.--. ..Lining maferial---------------- <br /> Size: Diameter- -_ ------------ ----------------Depth--------------- ----------- - ------ -------------Liquid Capacity------------------------------_gals. <br /> Privy: Distance from nearest We]L--------------- --------------------------------Distance-from nearest building-. <br /> ❑ Distance to nearest lot line ::------------------------------- ----------------------------------------------------------------------- --------------------------------. <br /> a t <br /> t Remodeling and/or repairing (deseribe� r ---------------------------------------------- <br /> -- c <br /> f � <br /> --------------------------------------------------- <br /> - <br /> 1- _ ----------------------------------------------- f - -- - - ---------------------------- <br /> - <br /> Fil <br /> -- -- - ---------- -------- ------------------•-----•------------------ ------------------ ------------------------------------------------------------------------------------- --------------- <br /> l hereby certify at 1 have prepared this application and that the work.will be done in accordance with San Joaquin County <br /> ordinances,-State,[aws, nd rules and reg .,.ations of the San,doaquin Local Health District. <br /> t^ -.(Owner and/or Contractor) <br /> (Signed)_ € .. �. <br /> z . x <br /> }•i� <br /> ':q}' A: 3 <br /> B � ~ . ,t i-"`-`-�36rA'=E= ---------- <br /> .4 <br /> ------- - Title)--- <br /> (Plot <br /> e) -.. - <br /> Y•----------------- ----� -..-. -_ ( -- <br /> (Plot plan, showing size o"t lot, location of system i relation to wells, buildings; etc., can be pla d on reverse side). <br /> -- - FOR DEPARTMENT.USE ONLY <br /> = r - <br /> APPLICATION ACCEPTED B - ------------------- ----------------------------------------------_.--- DATE-=----- -o�-~�-�---- <br /> - ------ <br /> REVIEWEDBY---------------- -- ------ --------- - - ----=---------------------------------------------------------------------- -- DATE------------------------------------------------------------ <br /> BUILDING...PERMIT ISSUE ------ '------------------------------- <br /> ------ -------------------------------- -------- DATE----------------------------------------------------------- <br /> Alterationsand/or recommendations--------------- -- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> Fit <br /> ---------- -------------------------------------------------------------- ----------------------------------------------------=------------------------------------------------------------------------------------------ <br /> w --------------- <br /> -- -------------------------- ---- ---- ---- ---------------------------- <br /> ------------ ------------- ------------------------ ---- -- ----- - - ---- -- <br /> -------- ------- ---- ------------------------.._..------- ------ - --------- -------------- ------ ---I---------------------- ---- <br /> FINAL INSPECTION ✓� - Date------- =---6 ^ 1��' <br /> - S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.-Hazelton Ave, 300 West Oak Street 114 enc <br />