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Y 7 ' 9 APPLICATION FUR SANITATION PERMIT Permit No. _. ....___._ / ., (Complete in Duplicate) -----_-_--- Date Issued ----- ----------it- ._..- This Permit Expires'l Year From Date Issued Application:is_hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe K This application is made in compliance with County Ordinancevo, 549i X17 JOB ADDRESS AND LCATION----t----------- --�`�--�------�----------------------------- --- ----""`-- Phone. � =---- - -------------------------------- ----- ---- Owner's Name__________ ------1v y - AddressJ�--y� -� 'd ,_.&�� f Loi-- =� ------- ° -----••-------••---------------------------------------------- /! �' Contractor's Name.-------••--. � - � ------------- - ------- - - Phone-------•------------- -------------- 1 Installation will serve: Residence Apartment House ❑ Commercial E] Tra'er Court ElMotel Other [I Number of living units: ___ - Number of bedrooms _-, _ Number of baths 7:_ Lot size ------- -------------------- I' Water Supply: Public°.system ommunity system ❑ Priv 0<3 Depth to Water Table 6/4—ft. r Character of soil to a depth of 3 feet: •.Sand ❑ Gravel ❑ Sand ~Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (if yes,date--------------------)__,No New .Construction: Yes [ E] FHA/VA: Yes p-- No [I r ` TYPE OF INSTALLATION AND SPECIFIC—ATIONS:4�-, - 7__� , [No septic tank-or cesspool permitted if' ublic sewer is available within 200 feet.] I G i Septic T Distance from nearest well w--- __._______Qistance from foundation---`©----------M terial��_�___ ______ __________ No. of compartments---- 1 _-Size__45�c_}(�,0-------Liquid depth_' ---------CapacitY__1 -------- Disposal Fi Id: Distance from neares Well....- _. Distance from found tion__.�12-�__._.Distance to nearest lot lin�_�-.-_______ i Number of lines------- -------------Length of each line -- � Ati" --.Width of trench _C - _.__.____--------..--- Eik / !I i Type,of,fiiter, material_____��--ROCK-Depth of. filter material_-' -_ _.___ :-dotal length--_ aSC�__________________ _____ i Seepage Distance to nearest'well_____-77rr"-_____:_Distance from fo ndation_____ _ ------ -.Distance to nearest lot lij e__ ____ _.. 0 Number of pits-'.o�_c-_------Lining material__fl_4 ---Size: Diameter_ . ______________-Depth ___ - --------- Cesspool: Distance from nearest weal____________.._-Distance from foundation____________________Lining mater-sal__.__- __._._--- --_ ____.� Size: Diameter-----`- -----------------------------Depth--------------------------------------------r='---Liquid Capacity----`-----------------------gals, Privy: Distance from nearest well-_.__ :. r-:-==------------==-pistance from_,nearest building._________._____- ______________--_-_ ❑ ,�,_ -�-. �_t = - -------------------------------------- --- ------ -------- ----- �D.istance.to nearest lot Ilne_____ -._____ ---- -'-----� --------------�- � �p Remodefing and/or repairing(describe):-.---------------- -- - - ---------. --------------- 1h. . t ----------- p ------- ----�--------------- ------- -- _ 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 laws, and rules and regulations of the San Joaquin Local Health District. -------------------------------- St (Signed) R-040 _.(Owner and/or Contractor) { .g )---------------- - - ---- • B ---- - `' ---- i -----------------------(Title)....Q � > (Plot plan, showing size of lot, locaton of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------ DATE - ------------------ - REVIEWED BY---- - ---- ----- DATE-------------------•-- ------ BUILDING PERMIT ISSUED------------------- -"--�--`-------- --------------------------------------- ----------=----- - - DATE �---------------- =-`-^-----------`--�--------c-----fi---t-`---=--�--------------- ---------- Alterations ------------•- -.-----.. Alterations and/or recommendations:.____ =---- --- ----------------------------------------------------------- --- ---------------•-------•------------ ----------------•------------------------- --------------------- --------------- ----------------- -•------- --- -------- f - FINAL INSPECTION BY:.._- ---�-- Date--------'�