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r) <br /> -APPLICATION FbR SANITATION PERM <br /> Permit No. <br /> (Complefe to :[)upllca#e) <br /> --- ------ ------ t r - ------ / <br /> Date slued. -- <br /> .-_--.---- _ This.Permit Expir'e's 1 Year From Date Issued'-'. <br /> n is made in compliance with' Q164 Ordinance No. 549. P <br /> Application is hereby made to the San Joa uin,LA Health District fora erm'lt to construct and install the work herein described. <br /> I � This application p Y - � ;y--_•�',-�.. <br /> i JOB. ADDRESS AND OC ION <br /> -- <br /> �Y� 'p` i{ -------------- --- --- ---------------------------- -------- Phone <br /> ' 36 <br /> Owners Name ----------------------•------- <br /> Address-- ��_: l 1----------------------------------------------------- ---------- <br /> �L{ Contractor's Name. .- r_ <-------------- ------- ---------------------------- Phone me l <br /> �. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> of living units: __l-.___ Number of bedrooms __��_ Number of baths.--._�-- Lot size __ __C/ - _- ----------------------------- <br /> NumberR Water Supply_: Public system ❑ Community system ❑ Private Depth to Water"Table z_ ft / <br /> Character of soil to a depth of 3 feet- . Sand E] Gravel [jSandy Loam YF. Clay Loam E] Clay E] Adobe ❑ Hardpan E] <br /> Previous Application Made: (If yes,dote--------__.-._..._ No ® New Construction- Yes ❑ No I$ FHA/VA: 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 Tank: Distance from nearest welf-�?_ r__-__Distance from foundation-_-1Q�--------Material -_�?._ r} <br /> No. of compartments- _ -------- --Size--- 0-6--------------Liquid depth- r1. -- ...Capacity- CJ1::;70--------- <br /> _ <br /> Disposal Field:. Distarce from nearest well_.2"___.-Distance from foundation---)(7_--------Distance to nearest lot line__,----_.__ <br /> Number of-fines.---------`2-- --- ----Length of each line-- -d--------------Width of trench----------------------------------- <br /> yp - plength ----------------------- <br /> 7 e of filter mater�al___, �_ `� .---_De th of filter material__-_/ .___.__ Total __-___._ : <br /> Seepage Pit: Distance to nearest well----=------- -----Distance from foundation--------------------Distance to nearest lot line--_-_.__-_-_-.._ <br /> ❑ Number of pits- ---- ---- ------Lining material---------------------_ Size: Diameter-----------------------Depth_ "; -------------------- <br /> Cesspool: Distance tram nearest well________________Distance from foundation--- ._____ ..Lining material__.._-.__ a<_------------------ <br /> El <br /> -_ _._________. <br /> ❑ Size: Diameter Depth---------------------------------- -----------------Liquid Capacity----- -----------gals. <br /> Privy: Disfarce from nearest well______________________.___-------------------Distance from nearest building_.___-___.------------------------------- <br /> __ ❑ Distance to nearest lot line -- ------------------ ------- --------------- <br /> I <br /> ------------ ----------------------------------------- ----------------_------ <br /> Remodelir and/or re airin' (describe) _____ -� ---- ---- ---- --- <br /> - ---------------------------- <br /> ------------------------------------------------------------------------ <br /> ---------------------------------------------------------------•---------------------------------- ------------------I---------------------------------------------------------------------------------------------------- <br /> - <br /> ------------------------------------ ----------------------------------------------------- - <br /> ---------------•-------------------------------------- --------------------------------------------------------------- <br /> hereby certify-that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State laws, and.rules and regulations of the San Joaquin Local Health District. <br /> _-. Owner and/or Contractor <br /> (Signed)-�.�____� <br /> - --------- - -- -------------------- ------ ( ) <br /> :x--- -------- ------------ = ---------------------{Title) -------------- ------. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> ' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 6 _--- - -------- --- - --------------- - ------------------- <br /> ----- - ------ ----------- DATE--------- - - -�------------------------------------ <br /> REVIEWEDBY---------------------- --- e..------------------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUE ------------------------------- ---------------------------- DATE---------------------- ------------------------------------- <br /> Alterations and/or recommendations:----------------------- --------------------------- --------------------------------------------------r---------------------- <br /> ------------------- <br /> - --- <br /> - - -.-- <br /> ----------------------- -------------- ----- ------------------------------ ------ <br /> I �- r- - - ------------------------ ---- ------------- <br /> - ----------- - --- ----- -- ------- ----------------------------------- --------------------------------- -------------------------- <br /> FINAL: INSPECT( BY.. . <br /> = - 1 Date------------ —- / �. --------------------------------------- <br /> _._- _ - <br /> JO UIN LOCAL HEALTH DISTRICT <br /> l -k <br /> 1601 E, Haxellon Ave, .300 West Oak Street _ 124 Sycamore Street 205 West 9th Street <br />