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i APPLICATION FOR SANITATION PERMIT Permit No. ...J.../...fl (ComPfefe in Duplicafe) ��r Date Issued ................. Applicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin desert This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI/ONs. 'G .-._.- �.-.- �/��I .........e /!ted ! Owner's Name.........................�✓^ � � ........ . .l.. ........ ...t ..(�................ �' I ..s... .. .../........ . .Q.. .v................. Phone....... nn .......... Address..................................................�./...!/.L...... i .. .. ..:-... Q.�... ... ....... .......................... . ..........._......... ' Contractor's Name.............................. '. .`...................__...... .. ................................................................. Phone.................. Installation will serve: Residence ❑ Apartment House • """" V� ❑ ommerciel ($, Trailer Court ❑ M`fpl ❑ Other C]K Number or living units: ........ Number of bedrooms........ Number of baths l.... Lot size Water Supply: Public system ❑ Community system ❑ Pr!vafe Z Depfh to Water Table A.b{t, •r . Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam Clay Loam❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA:Yes ❑. No❑ TY?E OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Trot. Dlsfanco from nearest well. 5'4--D:stan a'`Pro �ja}i6 /� ® No. of compartments._..._."!/..,.......Size. ,1(-..�,q.-�._.•.Liquid dap+h C'a act �y�•.� - �..... ................. . p ty..... �.........- i Disposal Field: Distance from nearest well .75._�rr-Distance from foundation. .d=r:tr.,pistance fo nearest lot line.�',5... !.... ® Number of lines.........�"E-- Len fh of each line........ - i �- 9 17-- .....Width n french...��-- _ Type of filter materiaL.....21 .. ......:�Dopth of filter material......r(�......Totel length.......... .�:�_----------------'� f Seepage Pit: Distance to nearest well .............Dista.lce from foundation._........... . rants to nearest(of line:............. j ❑ Number of pits......................Lining material............:..........Size: Diameter.......................Depth..............._......... I Cesspool. Distance from nearest well.................Distance from ❑ foundation......... mate "'. y . ........ Diameter......................................Depth....................................._........... 0 ..: . uid an.cify............................gels. Privy: Distance from nearest well................................................Distance from nearest building.............. ❑ Distance to nearest lot line...................................... _ - -- -- Reawdalia�.n�,�oC-rsPai=-- N . . ._ .. r�...- ...................................................................................................................................................................................................... - ........ I hereby certify that I rule prepared fats application and that the work will in accordance with San Joaquin Counfy \(, ordinance', Sf s �d rules and regulations of the Sen Joaquin Local He - (Sigaed)....... ..... ............. ..................,.......__.._............................_.................................... ��1"' ....................(Owner end/or Contractor) By:..................................................................................;..............................................(Title).............................. ..................................\ gr (Plot plan, showing sae of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). (�\ FqR D ARJMENT)4SE O . APPLICATION ACCEPTED BY.......... .....__(/, .. .� .. . ......... ....... DATE...f.....T.. ......: ..... REVIEWEDBY......._--_........................_........._..._.-......................._...._-................................... DATE_...._...................._............... ..... --... -.... ....... BUILDING PERMIT ISSUED.............................................................-.........-............................ DATE.......................---.................................. Alterations and/or recommendafions:..............._............................................. ........ .............................................._.................... 7... �_..............7 /.. . ........... / ' ....................... -..._.�` 1J..1.5._ :....._ 1..---_ :L....__.../ux,r:...... !::..�... ...............................................:....� . ......... .................. .-.................... ..............................._........_.................... ................................. ..-................_....... . FINAL INSPECTION BY:...... /--.?�................ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amnion Stmt 300 Wet OA S1nN 132 SYumon Stutl 114 North "C"Str..f StncHon, GII(ornL Ledi, Celi(ornla M�ntGII(ornB Tucy. CdNnnls ES-9-2M. Revioo 1,57 F,?CO.