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<br /> Gg ............... . ...��L. . APPLICATION FOR SANITATION HERMIT Permit No.
<br /> ..................................r-. .... . . . (Compfefs in Dupfiute)
<br /> This Pormi" EDate Issued
<br /> x Trot i Year From Dato Fswed
<br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desen'E1ed.
<br /> f...,, —Plication is meds in compliance W cl;+ance No. 544.
<br /> Th;- -�, F'YI
<br /> r. a •,r P pence with County Ori
<br /> ESS AND LOCATION.....,SQ. .
<br /> !w���;;:'{: �rf'!•�te.+•;r...a � .0�!C. til -�
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<br /> . ...A.r.............
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<br /> Owner's Name..... ..a.... .................... Phone .Address ..
<br /> ........... .......... ....................................................... ...... .............».......»....»......;.
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<br /> Contractor's Neme...... ? ^
<br /> ..... ....... .... Phone. . .
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<br /> ` Insfallation will serve: Residence E& Apartment Hcusa f) Commerc?eI Trailer Court {'
<br /> ❑ ❑ Metal a Other'Q'_,5. '.=; f
<br /> Number of living units: ,.�.... Number of bedrooms.7';:. Number of baths-Z,.. Lot si;e
<br /> t Water Supply: Publics stem Community r ,
<br /> P Y �.] 'ty system Q Private (a( Depth to Water Table
<br /> Character cif soil to a depth of 3 feet: Sand❑ Gravel❑ Sandy Lcam❑ Clay Loam❑ Clay❑ AdabeZ] .Hardpan Q
<br /> Prmious Application Made: (If yes,dote I No '�
<br /> (� Now Consirucfion: Ye No f$ No ❑ FHA/VA:Yes Qg•. No O :r
<br /> TYPE OF IMSTALLATION AND SPECIFICATIONS: r
<br /> Iho septic tank or cesspool permitted if public sewer is available•,rifhin 20O foe?.1
<br /> w.e. L..... ..Q..
<br /> ..SDiz?set.a. fC• rti� foundation •
<br /> �. ...Septic Tank: Distance from neared
<br /> ?o. of compartments... . ..;...CcLiquid depth
<br /> ML
<br /> Disposal Field: Dsfance from nearest ....Distance f
<br /> from ,ound*t;on.....l..J.........Distance f nearest lot.line,.�$..,.;,'y
<br /> Number of lines Length o each I' y
<br /> 3...... ...
<br /> r•., •. . ......... g f � ..$�.....,.....��..W1dth of trepch......;�'-411., '
<br /> Type of filter materia '
<br /> >fy�...i.,� 1 .���--CA.C.k...Cepth of filter mai^nal........1.�.�..:..Total length....�4Q....»::;.:,_:..-..:�::':•',
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<br /> Seepage Pit: Disfance to nearest well........ D?sfanco from foundehon............ D t!in
<br /> .r ..
<br /> � a © Number of pits...... ...... ..Lining material..... .............Size: Diameter........sfance to nearest Iv.... e..-,..^...:
<br /> Cesspoo.': Distance from nearest well......... .....Distenro from
<br /> syo`.,y�x%'�}fl r°i .;':-.1.!!'. ❑ .....Depfh...............foundation- ............ .Lining materia
<br /> l....
<br /> .....Size: Diameter.. Liqu'd Capacity......
<br /> Pricy: Distance from nearest well,.......-- .... .....,Dstance from nearest building ........
<br /> _.._..
<br /> ........
<br /> gats•:
<br /> �•y Distance to nearest lot lino.
<br /> r,1L' - ...................... ..... ....... ..................................................................•......
<br /> Rem000l,ng and/or repairing (describe):.............
<br /> } .. ....................................._.......-.... . .... . . ........
<br /> . . ........ . ........................ ....
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<br /> 4a
<br /> . ..._ .:........... .................................... .......... .. .. ..................... . . .. ..
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<br /> .... . ........•••••................. .................................... ......
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<br /> I hereLy certify that I have prepared this application and that the work will be done in accordance with San Joaquin County .. c
<br /> �y ordinances. Sfafe laws, and rules and regulations of fho Can Joaquin Local Health District.
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<br /> By:.............................:.. ............. ................... ....................... oar and/orContractor
<br /> ....................................................�;if le)...... 4i
<br /> (Plot plan, showing sire of let, loceinn of system in relation to walls, buildings, efc., can be placed on reverse sidol
<br /> ' f 1 _ Y•.t w
<br /> •=.3 ��'' ___._ FOR DEPARTMENT U5J:ONLY
<br /> APPLICATION ACCEPTED BY.
<br /> .J
<br /> REVIEWED BY.. .4.........
<br /> ,.........:
<br /> .1
<br /> ......... .......... .. .. DATE .r.
<br /> BUILDING PERM1% ISSUED....... ..................... D4TF.... ""'
<br /> `.�..:Alterations and/or rocommenoafionr../ . . ....
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<br /> r ...>�!. .:,.14i.C��.�./�[!.f t�YL��..L(4f..•vi*�:4 e� 7E%r}MF,�..f�i.4�a�•is. �..
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<br /> ' ..s�X.r2...�-c.---s�o'T.�.s -� Gtrs/.x•t �a.,c1. C�.....
<br /> f,:.. INSPECTION BY:. ... . ....... Date..... ...." /.ar.. `
<br /> ... (es.................•..........................-. '..
<br /> SAN JOAQUIN LCCAL HEALTH DISTRICT
<br /> 1481 L.Havehen Ave. JOU ries?Oak 4ree1 124 sycamore Street
<br /> 705 Well 00A sheer
<br /> Sr�+c45e�,rali�ernia tedl Coli:ernla Menr•,o.Ca,ire,nla T,a,T,Colife A16
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