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APPLICATION FOR SANITATION PERMIT ., (Complete in Duplicate) Application 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 Ordinan e No. 54-------- ---;?_,�--- -------9. JOB ADDRESS AND LOCATION_____- 3 Owner's Name_ n ---- --------------- ----- -------•-- e �----�.-Olso---------- Address_•__.-__ Phone_ �-i. - -- - ----- -------------- Contractor's Name--------- _•- -- -_-- - ---- ------------- 1rs_J1_•r-� 4` ------------- ---- Phone Installation will serve: Residence Apar tment House Commercial ❑F�x..a� TraiCourt ❑ Motel ❑ Other ❑ Number of living units; �� Number of bedrooms � Number of baths � Lot size____ _ ___ Wafer Supply. Public system ❑ Communif system ' -------------------`----------- Y Y ❑ Private Character of soil to a depfh of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ C.� TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel!_15_0--------Distance from foundation_ e� XNo. of compartments--------� Ma erial---- , r -----Capacity--- Size-59 " Cesspool: depth..S'Y----- _______ p Distance from nearest well-----------------Distance from foundation .-Liquid material------------------------------------- Privy: _______---_----_____ ❑ Size: Diameter-------------------------------------- Depth------------------------- ------------ - - ----------- Priv - - -------- Y Distance from nearest well__________________________ F] Distance to nearest lot lineDistance from nearest bin__ _____________ uildg_____------------------------------------------------------------ --------------------- Seepage Pit: Distance to nearest well______________ _______Distance from foundation___________________Distance to nearest lot line__.__________ ❑ Number of Pits----------------------Lining material_._________ - -- ------_-Size: Diameter--------------- --- Disposal Field: Distance from nearest well_ O-_-_-- Depth_________ Distance from foundafion__ ►0'-- --_-Distance to nearest lot line_ Number of lines____-__---- Length of each fine_ ---------- _ g Type of filter material__ ��-- � Width of trench____!__ Depth of filter material----•�-pp-- 0 --------- -Remodeling and/or repairing (describe):-- ----------------- -- --------------- ------• ---- -- ------ -- Ag ---- -- ---------------- --- --- - --------------------r -------------------------------------------ereave ---------------------------------------------------------------------- -- --- --------------- -------------------------- I hereby certify That I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, a ules and' regula ' s of f e San Joaquin Local Health District. (Signed)_-- -_Xs y --------- ------------------------------ --------- d t•----- t - ntrac or(Title)- Or p ) (Platpl ns, shze of lot, locatio f sysfem in relation to wells, buildings, efc., must be filed with is application). z -tel FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ k _ _EVIEWED BY___________ -------------------------------------------------------------------------- DATE- - -------------------------------------------------------------------------------- ------------------------------------------------ BUILDING PERMIT ISSUED------------- DAT)-- �j! = ------------------------------------------------------------ QSI- terafions and/or recommendations------------------- DATE.---------- --- ------------------------------------------------------------------------------- ---------------------------•------------------------------------------------ PERMIT No—J-0---- ISSUED_- �` � (pate) FINAL INSPECTION BY:.______,-- Date--------•--------- � � ' ��- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E5-9-2M 9.50 W-1639 Sfockfon, California