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R OFFICE USE: <br /> ..! <br /> .` .- . 5-..........,.... .¢�1i. .... APPLICATION FOR SANITATION PERMIT Permit No. . <br /> .................................. .... (Complete in Duplicate) / ... ... <br /> �,L// ' <br /> ........... ........... . Date IssuedThis Form Exres <br /> 1 Year From Date Issued '` <br /> Application is keroby made to the San Joaquin Local Health District for a permit to construct and install the work herein descn'bed. <br /> licetion is made in <br /> Tb;. -npcompliance with County Ordi ante No. S49. <br /> DURESS AND LOCATION.....,.a <br /> 1 .r . 'Ilii .�........ . ..'..1.r................................................. ...... «... <br /> `s Owner's Name....... ..�. Y1.ti:,.4 <br /> - � ................ ._.. ... ...... ........................................... Phone....... <br /> i '?•'' ;) lddress.. ... )1�.0�r. �1...........A.Y..t.......... .. .•....................................................,...�.» .. <br /> jos Contractors Name......VWLI <br /> . . ✓1sT n. .... -. ...........R. ... ......� <br /> ... . .. tY . �7 '!1r►�� Phone .�...�.. ':.' <br /> Installation will serve: Residence M Apart Hcuse f, Commercial <br /> A ❑ Trailer Court ❑ Motel [j Other•©'.-,�,i:.,, �, <br /> .ry ,,� <br /> Number of living units: ..1.... Number of bedrooms..:::. Number of baths .�.. Lot size <br /> s r ,yf , <br /> 1 Water Supply: Public system [3 Community system ❑ Privaie I& Depth to Wafer Table ft. <br /> _ <br /> Character of soil to a depth of 3 feet! Sand❑ Gravel❑ Sandy Lcsm❑ Clay Loam❑ Clay❑ AdobenC "Hardpan04 <br /> Provious Applirafion Made: (If yes,dote ..... I No I3 Now Consimcfion: Yes )$ No ❑ FHA/VA:Yes No❑'¢ <br /> { <br /> TYPE OF tt-ISTALLAIION AND SPECIFICATIONS: =w <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feel I {;`r•1' <br /> "'S yjc 5 i <br /> Septic Tank: Distance from neare;t well....:'� .-...Distanco fvey foundation- C. <br /> }. _•.„ Mat . ', ' <br /> :> <br /> I� <br /> : ;;,.... No. of compartments...- .:7?;T......,.....Sixe..:.?...0 �.� .; .. Liquid depth.....11.�................Capecity.A�7...4 �1• <br /> e <br /> .+ . <br /> • r <br /> Disposal Field: Distance from nearest weiL.. ..(.r.....Distance from ioundation...,.L.-l..........Distance to nearest lot fine....] <br /> ($ Number of linos 3 ' r <br /> ....... ............... ...Length a each Irro.�-..$�Q.....'-..�L`..Wrdt of trete -�4f1 <br /> Type or filter materre'.j�4..�A.Gk...Depth of filter maNrial........1.-&.'..:..Total length....724.[40.._. <br /> ,r Seepage Pit: D.'sfance to nearest wall..... ___.. . <br /> ;;:°-. :• ................Distance from foundation..........._.__.__Distance to nearest lot <br /> f �: I ❑ Numbor of pits-............. ..Lining malarial..... ........Size: Diameter............... _.Depth................:...:. <br /> E . .Mstanco from foundation....................Lining material.2;-4 ..................,. <br /> Z. ,�- a •# Cesspool: Drsfanco from nearest well ... ,:•, -::':,�' <br /> r:'i <br /> 4' ❑ Size: Diameter... .............. .............:..Depth..............- .............................-....Liqu,d <br /> Prig Distance from nearest wetl. <br /> y ...........................................Distance from nearest building <br /> ity ale.'` <br /> f. ❑ Distance to noarest lot line.y ...................................................................................... <br /> ,...`-1'w! •: <br /> { r Remodeling and/or repairing (describe):............ ........................................................................................••..-•.................__.........� <br /> ............................... <br /> .:..................................... I......:.............:::........................ ...... .............................................................................. <br /> _....................................................-.................;........ ................................................................................................................................._.. s w <br /> .... ..........................".........................................-.........._................................ <br /> r I hereLy certify that I have prepared this applicafion and that the work will be done in accordance with San Joaquin County,-•Of <br /> y ordinances. State laws, and rules and regulations of the .an Joaquin Local Health District. I; <br /> . . .. ................ . .................................................. Owner and/or Contractor) <br /> ( s <br /> ..... <br /> 1: 8y:............... ... .......... ...........-.............................................r-fle)...... ........... <br /> (Plot plan.showing sire of lot, loca;inn of system in relation to waifs, buildings, ate., can bs placed on reverse side). } <br /> _ *" <br /> FOR DEPARTMENT USE ONLY <br /> : APPLICATICoN ACCEPTED BY... ... .. ....... ."................................. . ... ... .Y.... ..v ... <br /> REVIEWED BY.- <br /> F ya. <br /> 1. <br /> 11-1 <br /> C . . ...T �.�..Jc:..•htr...:esr[rt�re�.�.D/rAcTL;S <br /> BUILDING PERMI. ISSUED....... . ................... . DhTif ......... <br /> Aterafions and/or recornmenaationr...�:/./.(J.. rertw+_. <br /> ..... <br /> .. dn,,,N rrucrar. <br /> h .. <br /> z F,:.. . INSPECTION BY: ... �C' /' .. .... ........ .... ... ...... . bete.... <br /> ,y..�....................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> y M01!,Harallen Ave. JOU Wu!Oak Stnor 174 Sy[amsr•Street los well OrA sheet <br /> �l SMd»�,Cori 4[nie iedl Caf::o•nln Manrr,e,Cnlifom{a <br /> G7 Aa[y,Califanio <br /> F ti <br /> i ' <br />