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O OFFICE USE _ / i��,y0 <br /> _ l <br /> - s <br /> ..APPLICATION FOR SANITATION PERMIT Permit No. __�..7_�.+�-/ <br /> ---------- <br /> 1/aim--------------------- (Complete in Duplicate) Date Issued /6 7 <br /> -------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct.and install he work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB <br /> �-z — -- <br /> JOB ADDRESS AND LOCATION.-: ---------------- <br /> Owner's Name ? [ = == ----- {Phoria-._......`�--------------------- <br /> Address____ --------- <br /> "'"f"r-+ '- -z� / v # '� - Phone -' _ " <br /> Contractors Name------------ -- `L _.____••-�'--••---_____---- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑mailer Court ❑•.Motel L]_Other ❑ <br /> Number of living units: _____-_ Number of bedrooms ________ Number of baths _____-_ Lot size_.-_ -_ _��_ ____ _+ _______________ <br /> .7 <br /> Water Supply: Public system Fj"­I�ommuriity system ❑ Private ❑ be(pth to Water Table __-.,___ ft. <br /> Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam❑' Clay Loam E!'Clay ❑ Adobe ❑` Hardpan ❑ <br /> Previous Application Made: (If yes,date-----------. ......l No ❑ INew Co <br /> n'truction: Yes V4-'Igo ElFHA/VA: Yes ❑ No�� <br /> TYPE OF'JINSTALLATION•AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.] <br /> Septic •a`nk: Distance from nearest well '/t�"-___Uis#ance from foundation----1-U/`____.Materiallo � l--'�'- -- <br /> No. of•compartrnents___. � .-__Size___ � Xk*f Liquid depth___________ f� ' Capacity/ _[ `' s <br /> Disposal field: Distance from nearest from __-pistance to nearest louline____-------_____ <br /> Number of lines___ k ' <br /> --------------' ---Length of,each line---7 •- `a-- _Width of trench.-- --- U} i <br /> Type of filter material___ -P�r ✓-_Depth of filter material-.�c y�_ Total"lengt _ <br /> Seepage .Pit: Distance to nearestwell______.______.-__ J` istance from foundation___Z1?---------Distance to nearest lot line_--_*��__-- <br /> Number of pits__l.....'Z -____Lining material_ _ '- -Size: Diameter-,� .f/--____.Depth_____�? __-___y' ` r <br /> Cesspool: Distance from nearest well---- ------Distance from foun°dation___-..........-------Lining material---------------------------- .-.__- <br /> y Size: Diameter.:�--------------------- -- Depth Liquid Capacity = = gals. <br /> ❑ i } <br /> t <br /> Priv Distance from nearest well------------_----------------------____-____-____Distance.from nearest building-------------------------------___-----_- <br /> ❑ Distance to nearest lot line ------------- ------------ ---=--------,--- -------------------------------------- ------------------------ -----------_----------------Remodelin and/or repairing -------:- --- ---------------------- '- ' ``�f a <br /> -� <br /> .-�- <br /> �c�c { tJ lip <br /> ------ ---------I <br /> f--1---r-- -----------yf------- --"��- •--------- ---- -------------- -� -.....---•'r-•%-•-------•--•------------------ •----•-----•---S ------------------------- --------- .ryJ <br /> v -------- <br /> - ,fit I <br /> - -------------------------------------`------------------------------------------------------ _ _ -.------------- -------------------------------------- <br /> I hereby certify that I have pr p red this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and r gulations of the San Joaquin Local Health District. <br /> (Signed - ---- Owner and/or Contractor <br /> e - I <br /> t <br /> By: f - ----------------- -(Titl } <br /> 4 � <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed-on reverse.srde}. <br /> l FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY________ / <br /> cam- �----- ---------------------- --------- DATE------- 4 ------------ <br /> REVIEWEDBY------------------------------------ -- ------------- -- = -------------------------------- DATE - <br /> BUILDING PERMIT ISSUED--------------------------------------------------- <br /> ----------------------- --------------- Pjl�TE------------------------- --------- ---------------------- <br /> Alterations and/or recommendations:----------kQ---/_-- . ---� f ��_'Y-��'----- `7%--`P --•'-`—�=-•,_----/-`._�--:T�------ <br /> t <br /> - - - .r <br /> ---•-•--•- ----- - -------- ------------ ---------- -------------- ---------------------------------------,-------------------------------------------- <br /> } <br /> FINAL INSPECTION BY:..4 <br />