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APPLICATION FOR SANITATION PERMIT Permit No. ........................ (Complgte-in Duplicate) Date Issued -__ This Permit.Ex fires 1 Year Eram Date Issued Application is hereby made to the San'Joaquin.Local Health District for a permit'to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. f JOB ADD ESS AND-LOCATION -� - ar ;3 � -------- C." ------ 1 _ ZPhor`ie..::._ . .�Z� Owner's Name----- =Address -------=------- -------- ...--- ---- --u3 ......... -- .Cont'ractor's Name-------------- - ------- Phone Installation will serve: Residence ❑ Apartment_House ❑ Commercial ❑ Trailer Court .Motel ❑ Other ❑ Number of baths -------- Lot size --------------------------- ctom „ Water SupplyNumbe. Publiof Ic system Community sy�emm❑ Pnvate ❑ Depth to Water Table.:�-S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M--Pardpan [] Previous Application Made: Yes ❑ No E3, slew Construction: Yes ❑ , No E�- A/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: p Distance!'from nearest well-----------------Distance from foundation___'______________Material_______-_----_._-____.___-__________---__.___-_. �e No. of compartments-------------------- ----Size---------------------------------Liquid depth------------------------- Capacity----------------------- Disposal Fie Disfance;from nearest well----------------Distance from foundation_ .....___-_____...Distance to nearest lot line---.------------- Number of lines-----------------------------------Length of each line------------------------------Width of french------------------------------------ Type of filter material----• ------- ...... Depth of filter material-----------------------Total length----------------------------------------- _______j Seepage P• Distance to nearest well______ '' `-Distance Irom foundation--Z_Q__�......Distance to nearest lot line--:4: -a-�- -_ ---------- ----Size: --_____- �---Size: Diameter- � -----"-:Depth---.rx _S_ .-_---"."------ ��Humber of pits-_ ---------Lininmaerial--� � `Cesspool: Distance from nearest well __-__-_______-Distance from foundation______________ Lining material-------------------.------------------ » .�❑ ._ Size: Diameter -----Depth __ _: Liquid pacity_ Privy: Distance from nearest well------------ --------------------------------------Distance from nearest building-_-_______.__ _. _-________-.___- --. ----------------------- Distance to nearest lot line--------------------------------------------------------------------- ----------------------------------------- Remodeling and/or repairing (describe)-------------------i�- 4549 - __ -" - ,-. ---------------- --------------- ----------- I hereb certify that I have prepared this.app lication and that the work will`be'done in accordance with San Joaquin County Y Y P p , ordinances, State laws, and rules and regulations of the Sari Joaquin Local He h District. E L ?4, d� r------- �----- Yv� �- (Owner and/or Contractor). (Signed)---------------------- -- --A--��----- --- -�� B " -----{Title)----- 1 4- Y=------J-� (Plot plan, shor� - tion of system in relation-to wells.,buildiri