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FOR OFFICE USE: ---------------------- - --------------- - --_ ------------------t4W____-_. APPLICATION FO SANITATION PERMIT Permit No. (Complete in Duplicate) aDate issued * -- - i This Permit Expires 1 Year From Date Issued Application is hereby made to the`San Joaquin Local Health District for a permit to construct and install the work herein d"escribed. This application is made in compliance_,.with Cou�y�O�rd�nce No. 549. � / R " JOB ADDRESS AND L CATION. -_ ------ ----- --- --------------- ----- -------- Owne'r's -- `.�. r --- - ------- -------------------- --------- Name--------- - ---- - Phone- Address h Address -------5-13tc? _.._..---- ,e Contractor's Name----------------••----• ---•-------•-----••--- • ---------•------------•---------- Phone-------------------------•-......... ' Installation will serve: Residence Apartment House ❑Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _:. ___ Number of bedrooms .______- Numbe��of baths ---L--_ Lot size ___®__ Water Supply: Public system ElCommunity system [1 Private �pth to Water Table .fay?_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [} Clay Loam ❑ Clay ❑ Adobe, hardpan ❑ Previous Application Made: (If yes,date------ --------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pti Tank: Distance from nearest wellQ f--Distanc from foundation_-�J � No. of compartments_-._.___ ----------Size_.l�- P r Dis osal Field: Distance from nearest well. 40--1-__Distance from foundation_____�M----------Distance to nearest lot line______ �+ Number of .lines--------------- -------------------Length of each line-------------t�Q_-!--------Width of trench-----_------� ':L�---:-----•-- e Type of,fiiter material-� _ __ 1 t�,DEp+h of filter materiaL._-_____�� i --_ ' f f -Total length--------- 11 Seepag it; Distance to nearest well___-_ .______Distance from fo ndation__-- �� - - Size: - iZ! Distar5ce to nearest lot line__-____-_-_____- ''Number of pits-------- -l--------Lining material__/?--c'�_ eter---- -----------Depth------ 5------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______ -____________-_ ❑ Size: Diameter---------------------------------- -Depth------------------------------- - Li uid Ca Capacity p Y -----------gals. Privy: Distance from nearest well_____________ ----------------------------------Distance from nearest building. ❑ Distance to nearest lot line-,... 4 ''k----------------- ------------ r `----- p Remodeling and/or repairing [describe) - =' ----------•---------------•----------------------------------------- } _ 1 ----------------------------------------- - -� .H, I hereby certify that 1 have-prepared this application and,that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andiregulatians of the'San Joaquin Local Health Dis rict. '(Signed 1 ., ---r ,,: �� . --------------------(Owner and/or Contractor) By:._. -----------•---------- ----- `--------- ------------lr+ le)--------------------- ---------- ----- ---------- [Plo+ plan .showing siz of lot;:location of system ri Deletion to wells, buildings, etc., can be placed on reverse side]. I T7 ' FOR DEPARTMENT USE ONLY - :• APPLICATION ACCEPTED BY __. •- - c--d + ------ -------- -- DATE____ REVIEWED BY _ --�ISSUED BUILDING , ! PERMIT -•- --------------- ---------------------- ----- DATE-------- ------- ----------- - -"-__ ------ �.. -- ----'- --------•-------------------------------------------- DAT Alterations and/or recommen ati ni: - a =` - ------ --------- ---- ----- -------------------------------------------------------- ------------------- ------------- ------------------------ --- f