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vn vFrv�_r uat. e ------------- ------ ------'--------- -- -------------- --- -. --:__:: APPLICATION FOR SANITATION PERMIT i Permit No. __c� c�_. (Complete in Duplicate) - ------------------------------------- -- --------- This Permit Expires 1 Year From Date Issued - - Date Issued �`�,-��•-� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance Oss-- 230.-0 2_. JOB ADi)RESS A` LOCATION. 7a , ---- --- ------------- - ' Owner's Name_ -----. ------ --- --- �. --------------------------------- _ J • Phone Address.--•------- •--- ----_ Contractor's Nama________ --,_--__-_- ------•---•---------•---•---------•-------•---•--•----i--� ---- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ r� _ Number of living units: __1___ Number of-'be drooms"_4'�Number o baths __: _- Lot size Water Supply; Publics stem ' ----••----------- -- PPY� y ❑ Community system ❑ ;Private Depth to Water Table _ .T-- ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Cla ; Previous Application Made: (If yes,date-..___.__- Y ❑ Adobe❑ Hardpan ❑1. l No.❑ New Construction: Yes ❑ No ❑ FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (N,6 septic tank or cesspool permitfed if public sewer is available within 200 feet.) Septic ank: Distance from nearest well- ` _ Distanced from f;undati n_-/O_�__---__-Materiai - No. of compartments - -----� ------ ---. p ----------- --Size__ r ,• �iqu+d deAth_ Capacity c' D+spos Field: Distance from nearest wei------- Distance from foundation---lP__�._-.--Distance to nearest lo} IineS!-' t ' Number of lines_-s______ Length of each line-------_. Width of trench---- --_'------:- ' Type of filter material__---__--�-�- -- Depth of filter material____.__ ---Total length_-__-_f 1 ••------------------ Seepage Pit: Distance to nearest well--------------------- from foundation____ _ + _ _____________,Distance to nearest loft line ---� � ❑ Dumber of pits-----------------_---Lining material__-_-_.___.__._----__.Size: Diameter__-----_____--_ •r -------Depth--------- ------ Cesspool: Distance from nearest well-----.-----------Distance from foundation Lining material-.------------ --- - , -.k 7 ---------------- El $ Size: Diameter-___;�_.- -__ ._ - Depth_.---_-- _Li uid Capacity- ---------------- q P Y ----gals. I Privy: Distance from nearest well---------- g_.__.______-__ - Distance from nearesf building Distance to nearest lot line- - ---------7 Remodeling and/or repairing [describe '- -- - ------------ -------------------- -------- --------- ---------- -------- - -------------------- --------------------------------------•-,-------- ----- 1, ------ ------- -----------------------------------------------------------------`------------------------------------•-----------•---------•------------------------------------•----------=--------------------------------------------. }j - ----- - e ----------------------- ------ I hereby ce that I have prepared this application and that the work will be done in accordance with San Joaquin County\ ordinances, St a la s, and rules and 're ulafions of the San Joaquin Local Health Districf. - (Signed)------- ----- ---------------- ----- i ' ----- ---�-- - ---- -------- - -- ----- ----------- ------------------------------------------------------ Title Contractor) (Plot plan, shawin'g size-of lot, Iocatio f` stern"in