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ROR OFFICE USE: ................... ...... ...... -:50 APPLICATION FOR SANITATION PERMIT Permit No. ziU2 . .... ......... ......... (Complete in Duplicate) — - ----------------- ------ This Permit Expires 1 Year From Date Issuod Date Issued 113 .Wicatiori is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein rjltled. his applicati en isjnade lq corripliagea with County Ordinance No. 549. 01;4. PA -i AES 7—A -1j, _L&.te JOB ADDRESS NjIXI'AlfV- Owner's Name ...... A ..... ......... Phone . . ........................... Address .. ..... . . ......... . . - . .9.4.at . . ......... ..... »,... ....... .......... . . Contractor's Name_ ak; . . ........ . .......... . ............. ........... Phone,----..... -------- . _....».. Installation ------- Installation will serve: Residence OrApartment House 0 Commaretal [3 Trager Court 0 MoNI 13 Other 0 Number of living units: ... J. Number of bedrooms -5 ---- Number of atks Lot size ...... Water Supply. Public system 0 Community systaPrivate [a"' Depth to Water Table .0... ft. Character of soil to a depth of 3 feet: Send Gravel [-] Sandy Loam C] Clay Loam [] Clay 0 Adobe [] Hardpan 0 Previous Application Made: (If yes,clate .................... ) No [] New Construction: Yes 21Non FHA/VA. Yes El Nom^ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank at cesspool permitted if public sower is available within 200 feet.} Septic mak: Distance from nearest wall.4 .....-Distance from foundation... 1,02 ........ Material..12A.B.C.I.C.r. .. . ........ 1,01, No, of co-nparvments. ... _ .... . ......... Liquid Capacity--tW_ -IR Disposal _Dell: Distance from nearest well.._.'_.,........ Distance from foundati*n..,1.12..I..-....Disiance to nearest lot llne..17f__. BY Number .......... Length of each ....... Width of trench.. Vit:._._....._._.... Type of filter material.... Pa ..... ____ Depth of filter material. _!L. -..Total length...... '.....................•., Seepage J Distance to nearest _......Distance 4vm foundafion....,Za.,��....-D�,stance to nearest. t linj - --------- JIMI CV Number of pits.....) Size: Depth.. .. . Cesspool: Distance from nearest wail..,....,_........ Distance* from foundation... ____Lining material .............»,...,.,....._.....,._ ClSize: Diameter ................ ... ... . . ....... -Depth .. . ... . ...... . .............. Capacity....-.---- . ...... . ... gals, ivy; Distance from nearest wel ............. Distance from nearest building......_......_.,.. 4- 13 Dist;nce* to nearest lot ................ ....... .... ........................ Remodeling and/or repairing (desenbe) . .......... . . ...... ...... 4 IZ> . ............. .............. ............. ........ ....... . . . .. . ........ . . . ...... . . ............ . .. . . . .... . .......... ................................ . ..... . .............. . . ............. ............ ..................... ..._ . ....... ................ ............... . . ...... _ ......................... .- I - I . ................... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St4fr . and cul regulations of the San Joaquin Local Health District. . ...... . .................. .... ............ . ........ ...... ..... --(owner and/or Contractor) ---------- - -------- - --------- .................... (Plot plan. showing srims location of system in relation to w*#s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPUCATION ACCEPTED , la ......... . ................»,................................. ............... . ...... . .... ......... — ...................... REVIEWED BY._._........._..... ....... - - - — ----------- --- ...... DATE . ....... . ..... BUILDING PERMIT ISSUED ............................. ....... . ..... ...... ... ~DATE XA_ , ................... .......... . . ........ Al+eraifiom and/or recommendations.... .. . ........... . ...... . .. ............ ..... ....... .............. . .. . .. . . . . . .. . ............ . .... . ........ . ...... . ......... . .... . ........... . ... . .. . . ..... . ........ ............ . .......... ........ ............. . ........ . . .... I .... . . . ...... ........ ............ ................ ... ........ -------- ____ FINAL INSPECTION BY ...... ......... r4�*ce, e"s- ......... Dafe__4..._7,S ...... ( . ...................... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 S. Wasolton Ave. 300 W*%* Oak Street 124 Sycomate Ststti 205 W*W 9th atrsrt Stoaftri, CaUfornia Loll, CoMotnia manf*ttl, California Traty, California