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- -- APPLICATION FOR SANITATION PERMIT Permit No. .. .___ ---------------------- ------------------------ -_--- (Complete in Duplicate) Date Issued 1D. a.�, :-__.._---._..---_____-._....._._._____------ This Permit Expires 1 Year From Date Issued -__._ his Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dessccr�i'ed�Jv This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATION. z�.._JJ�.. f�-.-__ _.__.______. . -� /� ` 33 Owner's Name---'--'- //f'----7----"`""_"'mss.f--------------------'----------------------------------'----------- Phone----- 3.S�- Address-_---------- / -------- ---------- -------- --- `, Contractor's Name------_------ -- ---- --- ---- - -------- -� -- Phone._:5we�.'.._.11..�f--.. ------------------------------ Installation will serve: Residence ❑ Apartmenf House ❑ Commercial ❑ Trailer Court [:1 /Motel El Other El Number of living units:/--- Number of bedrooms ._>3_ Number of baths _ Lot size .__ __ -+t/_.-. Water Supply: Public system ❑ Community system ❑ Private gT-�Depth to Water Table F-- ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ an y Loam El Clay Loam E] Clay ❑ -Adobe ! Hardpan F-11r Previous Application Made: (If yes,date ) No ; New Construction: Yes ❑ No W-4FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r,. �a;nk; Distance from nearest well.------ ---------Distance from foundation_------------------Material----- --------._.____--_---___. No. of compartments-------------------------Size--------- ----------------- Liquid depth-----------------------:Capacity-'_--_--'-�-,�-- Disposal Field: Distance from nearest well 5- .--_-.Distance from foundation.___,�i,,.42-.---Distance to nearest lot line__.-✓-- ` ❑� Number of lines----------- __.... Length of each line._. l_d._._. _..Width of trench t r- - Type of filter material.-- t _- OCAj Depth of filter material__ ____Total length----„h_a.._._.___.___.__ Seepage Pit: Distance to nearest well_....................Distance from foundation-------------.__.__Distance to nearest lot line__.__________..._ ya ❑ Number of pits----------------------Lining material------ ------------ Size: Diameter_--------------------Depth-__--__..._.._-_-_._..._._.__ _ Cesspool: Distance from nearest well..............._Distance from foundation------------------.-Lining material__----------_----------._..-_..� c ❑ Size: Diameter,.-- ------------`- -- -------------------------------------- --- --- - ----Depth- --___ Liquid Capacity - - ------- ---gaf Priv Distance from nearest well---------_____ -----.--------------------Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------------'--------------------------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------'----------------------------------'-----------. . --------------------------------------------------------------------------------------------------------------------------------------- -- ------- ---•-------------------'-----------------'-`----- --------'-- ----------------'------------ I -------------------------------------------------------------------------------------------------------------I ----------------------'-------------`-------------------------I--------'------- ----------------------------------------------------------'-------------- L 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and reg tions of theASanjJquin Local Health District. (Signed)----- -----------' ----- --------- -' -- (O er and/or Contractor) ---- ------------------- ---- Title- --- --- -----4_1L...... -- - By:---------------------------------F- --------- --- -- -- ----- ---------- ( ) (Plot plan, showing size of lot, location of system in relation j/we Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... -------------------------- ------ --- --- - ---------- -- E---- c - L REVIEWED BY------------------------- - - ._ ATE-- - -" BUILDING PERMIT ISSUED---------------------------- ----------------------- � TE - - - - - - Ft - Alterations and/or recommendations:_-____--------------.--__ - ------------------------------------ ---------- ---------------------------- ------------------ --------------- -------------- L -- ---- ----------- ------------------------------------------------ ---------------- FINAL INSPECTION BY:-------- - --------------------`- ..` Date ----// - / - 4- I ---- --------------- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.He:elten Ave. 300 West Ouk Street 124 Sycamore Street 205 West 9th Street