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.ti:. OcPCE USE; I .._ APPLICATION FOR SANITATION PERMIT Permit No. .i. ...! ?.�..../ - - - (Complete in Duplicate) -` - -- -- This Permit Expires 7 Year From Date Issued Date Issues S• r_c.l Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the www herein described. This application is made in compliance with County Ordinance No. 549. �✓ r ... JOB ADDRESS AN OCAT ON..iy....._ Owner's Name_ y/ I .. .................... . ............... .... .. . ....... ....... .... ... ... . - .... ...... .. done... Address.......'(....... ._.. .. ................._...................__.._...................__.-........_' ...................................... / . e Contractor's Name.......... 11 .......... ....... ............................................. Phone....................._......_... ...!!is!.v '........... Installation will serve: Residence L+1 Apartment House 0 �1 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ./... Number of bedrooms 2.. Number of baths Z.. Lot size ........ >�L r. ................................. Water Supply: Public system E] Community system ❑ Private le Depth to Wafer Table"ilOft. Character of soil to a depth of 3 fee+: Sand❑ Grave! ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe&Hardpan❑ Previous Application Mede: pf yes,date......... ......__) No New Construction: Yes ❑ No [[2J0'FHA/VA:Yes❑ No E�— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet-) 5e tic Tankr Distance from nearest well.................Distance from foundation....................Material.............___............................. . No. of compartments..........................Size................................Liquid depth..........................Capacity....................... Or p� 0 i S Disppsal Field: Distance from nearest well... .....Distance fromfounda+ion..p.Q...........Distanca to nearest lot j ilg f' Number of lines.........../.... .... Length of each line...�Q...... Width of trench....A........................ ter ,............. w E � Type of filter material..,�y/L'p�:..Depth of filter material..-.r(dCCs..-.......Total length....�,?Q...................:...... ' .. Y .i. 0,7......Distance to nearest lot line.. �.._ v weepage Pit; Distance to nearest we11...�6P.sQ....:...Distance from foundation.... / Number of pits... ./................Lining material-OIZPPI<._Size: Diameter..3a3Depth.,./.75................... - Cesspool: Distance from nearest well.................Distance from foundation_..............._.Lining material.................................... �- ❑ Size: Diameter......................................Depth..............._......_..........................Liquid Capacity. gals. Privy: Distance from nearest yell.................................................Distance from nearest building................................. ........ ❑ Distance to nearest lot line_............... ^�............................................................_----_--------..-----................................. ._.. i Remodeling and/or repairing idescribe):..............aA ---h�e�s rK.e° G�:-.............................-...........................__........... _._..................._....................._.........._.........................................._.........._.-._......_.............._.-...._................._.._..........._..------.............. `• 1 hereby certify that I have prepared this eoplication and that the work will be done in accordance with San Joaquin Counfy ordinances, State laws, and rules and regulatioos of the Sen Joaquin Local Health District. (Signed) ' ` I......... ....... ..............1Eb"jC[3rRd/or Contractor) i (Title) fC°.f�..•.•...... ............. ....... . (Plot plan,showing size of 10+, location of system in •trefion +o wells, buildings, etc., can be placed on reverse side). -- t — FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY.... ':.:_ -Ca... ................................................._.............. DATE..3..-..:4.'.5..-.da..4_................. .... REVIEWED BY............................................................................................ .................I............... DATE............................................................ BUILDING PERMIT ISSUED.............................................................._.. .................................... DATE......................_...__.............................. ............................ !!(! Alterations end/or recommendations:................................................................................................................................... Y .._..................................................................................... ................ ................ .. .................................................... ......... .......�......... �... : ......................................................... o ................... ........................................ • FINAL INSPECTION .......... Cate...__''..c....?-.X..-_t..1_...... ......... BY:.....L.:._..-).<�.�..................... SAN JOAQUIN LOCAL HEALTH DISTRICT 1 soo Sarlh Amarlmn Sirul JUO Wnl Oak Slraal 124 SYmman Sinal 205 Waal elh S1,w1 Slrv<Non,Celilarnla L.cn.Cellf.mla Manlaw,C.11f.nla Tracy,cullrarnle II