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FOR OFFICE USE< t --------------------- APPLICATION FOR SANITATION PERMIT Permit No. .r,Q . ---- ---------------..................... ------..- (Complete in Duplicate) ------------ -- -------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Sen Joaquin Local Health District for a permit to con ct end install the work herein described. ! c This application is made in compliance with County Clydinaryrq,;..N9. E JOB ADDRESS A LOCAT10NIAJI;-�J1 ,x r(��.f�J -/-N- �._ !�_-----.------------------QxSI�R- Owner's Name..___ ----•------------------- - •-................. -�p - Address— .�_w.....».«._».« ..�....... Contractor's Name - , rte.. --'!*-------------- Phone------------------------....... Installation will serve: Residence eApartment House❑ Commercial © Trailer Court © Motel ❑ Other ❑ Number of living units;... _. Number of bedrooms./---Number baths_11 Lot size Water Supply. Public system 0 Community system ❑ Private Depth to Weter Tabka_._.__.. ft. Charaeier of soil**a depth of 3 feet; Sand❑ Gravel❑ Sandy loam Q Gay Loam❑ Clay idobe❑ hardpan❑ Previous Application Made: {If yes,date-----------------_-) 'No❑ Naw Construttiorr: Yes o No❑ FHA/VA:Yes© No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearost well------------------Distance from foundation..._...............Material........._------------------- ••.----- -•--(h F-1 No. of compartments...................��--Size -------------------_Liquid depth......--------...........Capacity_-------- .;----- _1 � Dispo eld: Distance from nearest well...-Via-t-YDistance from foundation--la'_--Distance to nearest lot line _�_'........ Number of lines.......... ....--.----_-- - -Length of each line-- �_p--.....Width of trench.-.?1-;--------.---------- -- Type of fiiter materiel...-_._s�'- �,::_.Dipth of.filter material._.....Lf.------..Total length--.--v Z--=-------------------.-.-- Distance to nearest welE.._1.0A..".1.:_.Distence from fou1. ndation.._. .@_i.._._:D�sjance to nearest let line-_.f...._..__ IJ Number of pits...... ....... .Lining material......V .!...... Dept#...... ....... 1 Cesspool: Distance from.nearest well......._.......Distance from foundation............--_...Lining material-.__..-_._-_.-___.-_..._.--_---_. 1 ❑ Size: Diameter---------------- _.-.Depth -..well................... from nearest.building-------------------------•----.-...._.._. ❑ Distance to nearest let line-------- -------------------- Remodeling -- -- — --- - -- e and/or repairing describe):....... ... .......... '----------- ---- -- ..-_-_.................-- .- -.... -.....I-------.__.----............._...-.-_....._ .. _....._.. _,__.... _ ---••----------------------------------------------- � ----•-.._.._...-----------------------------_.................................----................---- ------------...............-......•-................_.....---............. I hereby certify that I have prepared this application and that the work will be done in.accordance with San Joaquin County ordinances, Sta a and rules and regulations of the San Joaquin Local Health District. > (Signed) .... ._.._._-�._.._._ . ._.- ....... .. .......................................--....------........-_....._..........._._----. rid/or Contractor) ----------------------------------•-•-•--- (Title)----•----------------........................................ (Piof plan.showing size of lot,location of sysfam i lefion to walk,buildings,e+c.,can be placed on reverse sidol j FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY- --. . .. -------•------------------------------•-----DATE.- ............................. REVIEWEDBY---------------------------- ........................................................----.......__.-.--------....DATE------------------ ..---------------------------------- BUILDING PERMIT ISSUED......,.-_ .... •--..-._..---•--..----- --------------------------- DATE---------------------- .......---•---------- Alterations and/or recommendations:--.... ------------------------------------------------ _..--- -' ......... .......................................... - -..... ----------------------------------------------------........................................................................-............ , 1 RNAL INSPECTION BY:..... ...... .... --------- Date.....�:..x�._�� SAN JOAQUIN LOCAL HEALTH DISTAtCT [ 1601 E.ifaaehan 700 west Oak sheet 124 iycwnere SttVW los watt 9th stmt F !'swift.,ColUamla Ladi•Calilamla Monis.Callfomia TM"'Wife..ia i nv.aa. I I 1