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' / 1 <br /> � <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...T ......... <br /> ;_App (Complete in Duplicate) Dote Issued o;_- <br /> Application <br /> lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in ccmpliance with County Ordinance No. 549. -n <br /> ! / l�t� t..v� �! �sC� .Z ./1.........................._........c..../.r........... <br /> JOB ADDRESS AND LOCATION... 6:u�^...�t�...:..........:....:......... ..,... ........ .. <br /> Phone. <br /> Owner's Name... ..c...�-�..� / ....... 7 .�.................. .6'...- ......................... ................ <br /> _.. <br /> Address.-._.._-..../�/.....1:::'.Z...�..........� ................... .�`=^-..��....j.....42.. ......... ............ ........._._...... .... ... <br /> Contractor's Name............................ J. r ......................... ....... Phone..........-................. ..... <br /> 2.C..... .. ..... ... . <br /> Installation wM serve: Residence d Apartment H se ❑ Commercial ❑ Trailer Court ❑ Motel;❑ Other ❑ <br /> Number of living units: .-_ Number of bedrooms . Y. Number of baths ..�... Lot size .. '.'Z =-.`�•-•�`•• �C-� ''t <br /> Water Supply: Public system ❑ Community system ❑ Private_a_.Depth to atjable <br /> C horecter of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam& Clay Loam(f Clay❑ Adobe❑ Hardpan I•] <br /> previous Application Mede: Yes ❑ No 0/ New Construction: Yes [I'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank at cesspool permitted if public sewer is available within 200 feet.)/ 6 <br /> "�'a-7'`-=1, <br /> Septic Tank: Distance from nearest w�ell..aCO.�'.f..Distance from fouundation.....9/.�+...-.Material_.. `.E:�:..... ....... ....... ....... <br /> depth .........� ... Ce aci <br /> No. of compartments. �'.... ....Size.. .� :. .....Liquidp, p ty.........0Q......013 <br /> ��-- <br /> Dis I Field: Distance from nearest we!I-_ �� e Uistarce from foundation_q_ei// .....Distance to nearest lot line. ;. .......... <br /> Number of lines.......f...._. ....... ... .Length of each Gne... ,.Z.�..�.. •...•.Width of trench. ... . _•. •••••• �a <br /> i <br /> Type of filter material..S"f Xc_Depth of filter material.... ..../ I. ...Totel length.. ...,�.1••• •-•-- --- •• <br /> C fQ Di tante o nearest lot line <br /> Seepage Pit: Distance to nearest well ,�. C...... .. .Distance from�foun�p3ioti... ............ � _ <br /> Number of pits .... / . -..-..Lining material.kl .G�. '� Diameter !/ C�. Depth Jl 1 1 <br /> �... `'' <br /> 9mat _ ... <br /> Cesspool: Distance from founnearest well............. . Dis+ante from detion v �nin el�el. <br /> 11Size: Diameter.... .. Depth. Llqu;d Capacity gels. <br /> ` Privy: s_�/'Distance from nearest well ..... Distance 4om nearest building . <br /> ❑it f J s /!•,� r •Yistence to nQ �. .t .c.r•, • /a:r.. . - 4 ..�°2-21 " ' <br /> C <br /> ~ Remodeling and/or repairing (describel: f/.' r: �" tc•.s .r,.,..r..�i".4 ,�:.':et�..r/+C ![.C. �r...L f..C.....ea.I <br /> ?<t.aar�,t� -4a.it �i1 <br /> • <br /> �!. / .0 •;..may"/fta-� S:.•`'.K�•... .�,...� .. ... ..vt.a ' <br /> iAy- 1.... <br /> ••��//" N:Q....r...C.LCt.dt.4L.,^......... ..tl.i.t..c.L.�- ...„ . .. - -�- ; <br /> I hereby certify that I have prepared this appiicetion and that the work will be done in accordance with Sen Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> Y <br /> .._ �.Z.Sa. '... . (Owner end/or Contractor) <br /> (Signed)............ ... r..........,.... . <br /> By:........... .......... <br /> . ................................. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). --FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... . DATE <br /> REVIEWED By DATE i <br /> BUILDING PERMIT ISSUED - f/-`�� <br /> DATE <br /> Alterations tnd/or recommendations: <br /> _. . . ...-, . . ... •.,acs. ... .' _ i . . . • ' <br /> -'r:AL INSPEC ! aY <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ..� <br /> 137 SOON A+•«­u. Sh..f 300 W.,# 0.1 Sfr.., SI♦ N,,01 "C' $1r..• <br /> $toeHe•. C�I�ro•^�• Lod. Ceflorn'• <br />