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1 <br /> ►. FO <br /> APPLICATION FOR SANITATION PERMIT Permit No. �� �J.- <br /> _ - _-------------- - -._- ... (Complete-in.Duplicata)r - Date Issued, <br /> ------------ ------------- .__ _. This Permit Expirds T Year From Date Issued <br /> Application is hereby made to the San Joaquin j -Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with; C+`unty Ordinance No. 549. <br /> L JOB ADDRESS AND-LO <br /> Owner's Name__/._��_.f.HC`.__. `-.-- -------- ------ --------------------- ----- U —=- <br /> Phone. <br /> 99 �------ � <br /> Address-- ,2.4; . -�{ � _.. - ------------------------------------------------ ---------- - - -------------r- <br /> is. Contractor's Name_�x---- /— - -------------------`------------------------------- ----- <br /> Installation <br /> -Installation will serve: Residence on Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 1r Number of living units: -(----- Number of bedrooms - _ Number of baths ---l._ Lot size �--_._----------------_------ <br /> Water Supply: Public system ❑ Community system ❑ Private P Depth to Water Table - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam 9 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> ►r Previous Application Made: (if yes,date_...-.._..._..... ) No ® New Construction: Yes ❑ No [a FHA/VA: Yes ❑ NCO <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_ .Q..._.Distance from foundation_.1Q�-___---Matenal._ '.- __ __.._ ._.___..- <br /> _ ® No, of ---------.- _ <br /> compartments_-_�.-.._.------.—Size---le>o� Liquid depth _0-15--- __----.Capacity__ --------- <br /> _ -leloo-- <br /> Disposal Field: Distance from nearest weICJ.O--------Distance from foundation---/-a. -------Distance to nearest lot line_-..5�.�.... <br /> ` �' ...__.-- . Length of each line__.,_3d _ Width of trench_PZ _"--.-..-....._-__ <br /> ® Number of lines. ____.___._.__ g �------`------------- <br /> Type of filter material__ 6.- --_-Depth of filter material--/0---.__.__._Total length_._....`- ------------------------- <br /> Seepage <br /> _._-___.-_.-..._. <br /> t Seepage Pit: Distance to nearest well-_------------------Distance from foundation--------------------Distance to nearest lot line--------.------- <br /> ❑ Number of pits .-__- Lining material..._.. ._.--- Size: Diameter Depth <br /> ._.._.. _Distance from foundation. -- lining material.. ..... . --- <br /> 1 Size: Diameter-.- --.-----.--.---------..-Depth.-------------.-'---_.-------._-._-----.Liquid Capacity els. <br /> Privy: Distance from nearest well-__...___-.-_----__._._-..----.._.._Distance from nearest building-__.____._,._.__--._-__-.___-_ <br /> Cesspool: Distance from nearest well .. <br /> ❑ Distance to nearest lot line-' --------.---------------------------- ---j�------------------------------------------------- <br /> Remodeling and/or repairing (descriUe):_ e��t _- _. z _—C,_ � -----`C # <br /> --------------------------------`--------- ------------------------------------------------------------------------------------------ ----------------------------------------------- <br /> L - -------------------------------------------- --------------- --------------------------------------------------------------------------- <br /> ------ ------------------ ------------------------- -------------------------------------------------------------------------------------------------- ----------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State flaws, and rules and regulations of the San Joaquin Local Health District. <br /> L (Signed)--- e O--- ----------------------- -------------------- --- -(owner and/or Contractor) <br /> ----------------------------------------------------(Title)-- - -- -`- ---------------___- - -- -- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> fr <br /> FOR DEPARTMENT USE ONLY <br /> lAPPLICATION ACCEPTED B - - ----------------------------------------------------------------- DATE-------7./-S - -- ------------------------- <br /> LREVIEWED BY -- ------- ---- ------ -------------------------------------------------'__----------- DATE- ---------------------------- <br /> BUILDINGPERMIT ISSUE - - ---------------------------------------------------------------------- DATE--------------- <br /> and/or recommendations::----- --------------------------------------------------------------------- ------------------- ------------------------------- <br /> -------g+;.------- ---- -- <br /> ---- ---—--- ----- <br /> ------ ---------------- ------------ ---- ------------- ---------- - -- - - - -- ------- - ----------- - - -- -- - <br /> ----- --- -- - - --------------- . <br /> - - <br /> - - -- -- --- -- -- - <br /> FINAL INSPECTI BY:..- — .. __ Date - ------- <br /> - ----- ------------------------ <br /> JO UIN LOCAL HEALTH DISTRICT <br /> 1601 E.HauOon Ave. ..300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />