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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete In Duplicate) Date Issued <br /> Applica4ion 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 compliance with Cour4y Ordinancs NO. 549, <br /> JOB ADDRESS A LOCATION...-4ZZ 4� ..... ...... <br /> Owner's Name... CAII........A4-AJV..!.rr.Z........................................................................ Phone.........._........-._......_... <br /> Address............. <br /> ContractorsName......................... .. .................................................. <br /> Installation will serve: Residence 0 Apartment House E] Commercial IX Trailer Court [3 Motel [I Other ❑ <br /> Number of living units: J.... N.mbar of bedrooms ../.... Number of baths 2.... Lot size ............................. <br /> Wafer Supply: Publ% system [I Community system [] Private PQ Depth to Wafer Table *61t. <br /> Character of soil to 4 depth of 3 feet: Sand [I Gravel [] Sandy Loam E) CJay Loam 0 CJay 0 Adobe Hardpan 0 <br /> Previous Application Made: Yes [I No 9 Now Construction: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Rr <br /> (No supVc f,!ik or cesspool permitted if public tower is available within 200 40.) � <br /> Septic Tank: Distance from nearest well.... —....Distance from foundation..._...............Material.......................... <br /> [:] PAISITM& No. of compartments.....--.. .... ....Size...........................-Liquid depth........................Capacity ........ WM <br /> Disposal Field: Distance from nearest well I Distance from foundation....................Distance to nearest lot line....._.......... <br /> C]EXIS'"C- Number of lines................ ....... ........Length of each line...........................Width of trench................................... <br /> Type of filter material..... ....... Depth of filter material......................Total length..............................._......... <br /> Seepage Pit: Distance to nearest w4. ),2.0..' 1 <br /> . ...Disfaftce from foundation....AV—Distafice to nearest In, n. <br /> 1K Number of Lining mat*ria,J?.&5V<...Size: Diameter.....4j...........Depth... <br /> Cesspool: Distance from nearest wall.................Distance from foundation. ...............Lining material........ .........- <br /> 11 Size: Diameter..... ..... ..- ......... ........Depth....................................................Liquid rapacity.......... ...gals. <br /> Privy: Distance from nearest well.. . , - .............................. Distance from nearest builclin4............. ....... <br /> 11 Distance to nearest lot line .... .. ......... ....................... .................... <br /> Remodeling and/of repairing jc1escribo):... .,AJJI..70,P.A/...........2.'o............#`,K1.XX4e.V.45...........DA&.AMST -45.�47--� <br /> ................................................................................................................................................................................................................... <br /> .........................I........................................................................................................................................................................... <br /> ........... ......................... ................... .................................................................................................................................... . ......... <br /> I hereby certify that I have prepared this application and that the work will be done in accordance With Son Joaquin County <br /> ordl"ances, State bwrr rules and regulations of the Son Joaquin Local Health District. <br /> (Signed)............ .....I........................ ......(OWlaw and/or Contractor) <br /> Byl.... c............. rsev�. .Z........... ..................... <br /> sh'***'w"l*'n"g"s'i'z'*e"*o* 'a <br /> (Plot Plan. f lot, location of system In rotation f walk, butWings, ate-, can 69 p6c4 on reverse sldo� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8 ........... DATE...... .................... <br /> Y.. . .. / Lo -irr. . ........... . <br /> REVIEWED By..... ...... ...... ..... . ... -'- - I .. 1 <br /> .................. ............... DATE..... .................................................... <br /> BUILDINGPERMIT ISSUED........................ .......I..................................................... DATE................................. .. ...................._ <br /> Alterations and/or recommendations;............_ . .. ... ................................ ....................... .................................................. ................ <br /> ............­'­­ .. ' .' .. . .11.11 r, - . . I I I I . .. . ........... .......... ................ . .......I........ <br /> .....I............ .. .. ... .... ..... .1. . .. . .1 . .. 1 1-1 .. I . I I I ... . . .... .11 ... -.... I <br /> ........................ ......... ................. . . .................. ......... <br /> -.......... ....... .... <br /> FINAL INSPECTION BY:. . ✓ <br /> f f-2t Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 170 S.06 AmuwM Sf...# 100 Woo Oak st...f 132 S,e'..,. so'.0 $14 North "C" Sf,"f <br /> sf"IkMn, COVIC'.18 Ltdl, C.Vem;* mam.c.. C4140'Ma T,.,y, Call1o,,io <br /> f9-9-PA P..'.,l W.2100 <br />