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APPLICATION FOR SANITATION PERMIT Permit No.._fl1_� �•%.�.... <br />(Complete in Duplicate] <br />Date Issuod _1111.._ <br />Applice»ion is ho er by made � o e San Loral Hsalth District for nermi+ to tonstrurt and install the work heroin described. <br />is ;r scat' is rrade in rp:li e with C unty Ordinance wo_ 544. <br />JOB AD�J S� � C <br />61V,_1111.. <br />Owner 's ie GG. <br />Address__ .. ....----- -----------------_---- 1111_. ...-•---..- -- ..- <br />- <br />ConI ractor's Name ._ _ . - _.. ..__ ........ - Phone----- ------' ---........ <br />Installation will serve: ResidonceX Apartment House G Comrnerc'al F] Trailer Cou^t E] Motel ❑ Other ❑ <br />Numbe- of living units: �...._ Number o; bedrooms. Number of baths ./--._ Lot size _�.. ...................... <br />Water <br />Water Supply: Public systern ❑ Community system ❑ Private Depth to Water Table��_ ft, <br />Character of soil to a depth of 3 feet: Sand ['j Gravel [I Sandy Loam Clay Loarn ❑ Cloy ❑ Adobe E]Hardpar ❑ <br />Previous Application Made: Yes E] No Now Construction. Yes �' o ❑ 1 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: r \ r <br />[No &optic tank or cesspool pormitted if public sewer is e;ailsble within 204 fee+.I-'' <br />Sep - c Trask: Distance tram nearest �:ell__t---- Distance' from f�u;�rlat�on.'........Ir4a triol--.-- i7�(?- .--------- <br />No, of core artmonts-_ ... .Size <br />! Li uid de t� ,� � ' Ca dcit <br />.r <br />1]is,osal Eio►6. Cistarce from nears t we.44�7 ..._Distance from fcur�G,,lion.. Distance to nearest let <br />Number of lines .... / ------------------ Leny-h of each line..__. . .. .._'_......Width of trench__... <br />Type of filter rnaterin .........Depth of filter mn+eris.....�f....-Total longfh.......... . .... . <br />Soocagc Pia: Distance lo noarest well _Distance from foundation. .................. Dis-ancr, to nearest los lir:e................. <br />❑ Numuer of pits ................. Ii,: g material ----------------------- Size: Diameter ----------------------- Depth ................................. <br />ces1pool: Distance from rearr;st wel':.............. .. Distcnco from foundation............ _. Lining material ......... .......................... <br />L j Size: Dierrieler----.- ----- De;ah..__ ------ .................. Liquid Capocity ............................ gaIs, <br />Privy; DTs+ante frcrn.ncarost,r_eII v.Rs,.gs,.:n-r"..--.-:__.._� DTs*ante from <br />near building ............................. ....._1111. <br />❑Distance to nearest lot I;ne................ `....................... ---•---......................................................... .. <br />Rr;medcling and/or repAinn !(dcscri'�e):. 2..-----------------------------................................................. ,.......,........- <br />.......................... ......................•-•...........----•---•--...................,............--------•--•-•---............................................---•......,,.....- ..-.--------------•------ .......... <br />............................. ............ .1, ............................................ .......... .................. <br />I hereby certify that I -have prepared this applica#ion and that +he work will be done in accordancn•with San Joaquin County <br />ordinances, S +e laws, 3 rjililles and r gulafii ns of the San Joaquin Local Health District. <br />{ <br />Si ned ' --- J ------------------------------------------------ . ........ (Owner and/. r Contractor) <br />_ B ------ .---- r(./ •. -_ .1111. :.----------•--------------------•-------...._..• . Title !-� �� `�.. .k.: -�:�------j <br />(Plot plan, showing :iib'of to+, lots ren of 'system in re <br />tc webs, buildings, etc., can be p on raver side). � . <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED 13Y ...................... . . _1111.---_--__1.11.1._..------•--._......_. DATE... <br />REVIEWED BY.._... ---------- ---••---..._............ - ---�-------•-----_.---...................... ............ .------------ DAT E .......... . . - --111_,1......... 1111. <br />.... <br />BUILDINGPERMIT ISSUED................:.........--................................ ............. .,....................... DATE ... _........................ ......... ............__...... <br />Alterations and/or recommendations,- -•-------------- ------ - -----------1--- •------------•--------------------- -------------- ..................... 11.11-........... <br />-............................•---•--..................... ........ ......................... ............... ................................... _... -•-- ................. <br />FINAL INSPECTION BY:....... _ ... -- -- _ Date...... .... ....... . ...... ..( <br />