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FOR OFFICE USE: ---------------- '..--------- Z?02 _ :----,---------._,y_P__1M-_- APPLICATION FOR SANITATION PERMIT Permit No. ....... .. ........ �; --------------------------------------------------------�=_ ------------------ -- (Complete in Duplicate) Date Issued _ __:_�-�N. �� .._._ This Permit Expires 1 Year From Date Issued Applicaion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. _ JOB ADDRESS AND LOCATION--------- -- ___ ,1 ___ Owner's Name----------------- ---- ------------ Phone---------_----------------------- Address.......... -----------Address--•-••••-- --------- -- - � a11i / - -------------------------------------------------------___-----------------------------•-•- Contractor's Name______________________ _ --------- v ,< --- Phone---••---•---• Installation will serve: Residence Apartment House•E] Commerce 1 ❑ Trailer Court ❑ Motel ❑ Other ❑y - _ Number of living units: __-(-__ Number of bedrooms"". _ Number of baths 4_-_ Lot size ___T _.,,�__ __ -------/s Water Supply:w.Public system �mm-unity system ❑ Private ❑ Depth to Wafer Table to-,�ft. f, Character Jof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand oam ❑ Clay Loam ❑ C y ❑ Adobe Hardpan ❑ + Previous Application Made: (If yes date____________________) No New Construction: Yes o ❑ FHA/VA: Yes [ Flo❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep tic Tan Distance from nearest well---—'-------Distance from f undation_-0 -------Materiai_ �,��G,e---------------- No. of compartments__- _-________Size_ �,,e�_ Liquid'depth. / ___��................Capacity______b �_r) • Disposal Fi Distance from nearest well___-�-__-Distance-from foundation_4--------__:Distance toynearest lot line---I----------- Number of,lines------" �� -_ Length of each line__��_. ______.__.Width of trench_�.�______________________ Type of filter material.__/___�%. __Depth of filter material___ ___..___.__-Total lengti__/�____________________________ Seepage Distance to nearest well---- `-___--.Distance m foundation_/4�__ ......Distance to!nearest lot Number of pits__ J-___----Lining material__ _ _- Size: Diameter...�_1--------Deptn..,Lf------ ------ Cesspool; Distance from nearest well-----------------Distance from foundation--------------------Lining material___.___.-_.__-_---_____.--_-___-_-. ❑ Size: Diameter----------------'------------------=Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------- -."-_______________-__-_-__.-_Distance from nearest building---------------- -- � ❑ Distance to nearest lot Dine �' #----------------------------------------------------------•--- -------------- ---------_ ---:--- Remodeling 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, State and rut and regulations of the San Joaquin Local Health District. (Signed) l - -- ------------------- '--------- ---- Owner and/or Contractor) By: ------ --- L - ----------------------------------------------------•----(Title)---��- ---- - ------ - --.... (Plot plan, showing f lot, location of system m relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------17e--------------------------------------- ------------------------------------------- DATE------- --`-�. _ ------------------- REVIEWEDBY-------------------------------------------- -------------------- ------------------ ---------------------------------------- DATE---•--------•----------------------------------------- ------ BUILDINGPERMIT ISSUED_-------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or reco mendations------------------------------------------------------------•------------- -----------------------------------•------------------------------------------------- d �,„�� ---Z - __ __!2 -- ----- ------ ------ -- ---- -- �- -----.�..1 -------------------- ------ - -- -----•----------- ---------•---------------- •------------� ------------------- ---•----------------------------------------------------- ---------------------------------------------------- -----------------------•--------------------------------------------------- ---------------.... ------ ----••------------------------------•-------------------- ---------------------- 1 FINAL INSPECTION BY:.--------- Date--------- .-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=ellon Ave. 300 West Oak Street , t4 124 Sycamore Street 205 West 91h Street .' 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