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FOR OFFICE USE: <br /> _______________________________________ APPLICATION FOR SANITATION PERMIT Permit No. .1�. . ....`- <br />--------------------------------------- ------------------ (Complete in Duplicate) <br /> Date Issued <br />--------------------------------------------------- --- I This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. /SF1r/1fr3"E, f OS7 Ode*,.J'+10Y .e`er <br /> JOB ADDRESS AND LOCATIONI?X_a?----RX../ -------------ow.0-s1 ....... �»�.''y./ '4't ,f� e'�....4S?e t...:t o!n4, <br /> Owner's Name------ ...... '.I-.5`e,47 14 Phone.4 e:W 5P.sA.YR..7.. <br /> Address-----------------------CS/9/�?' '� -----•----.........---•------...... <br /> Contractor's Name.------ eCIstY_ �rjowx_ -•ZN-:............................................... Phone../W.0.94-7 <br /> Installation will serve: Residence Off"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _-_-_ Number of bedrooms s7-_- Number of baths/4 - Lot size ....... .AS"/g:mss'--------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [4i'Depth To Water Table::�P_ ft. <br /> Character of soil to a depth of 3 feet: Sand [v]0'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date________________----) No Eff" New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tan . Distance from nearest well --Distance from foundation___-__.___ ----Material .__._... ...................................... <br /> ❑ No. of compartments--------------------------Size----------------- ------•--Liquid depth-------------------------Capacity--------------........ <br /> Disposal Fi Id: Distance from nearest well__.0 �.--Distance from foundation-___Z4`'........Distance to nearest lot line....A..._.... <br /> Number of lines----_-------/----------------_----Length of each line...6.50_.......t........Width of french.......�Z.*1................. <br /> Type of filter mate --------Depth of filter material-----1-4-----------Total length_...0.4....: '.................. <br /> Seepage NJ;. Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits______________________Lining material.......................Size: Diameter-----------------------Depth................................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material..................................... <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------•-------------------Liquid Capacity............................gals. <br /> Privy: Distance #rom nearest well .-_-______________________________._.- -------Distance from nearest building-____--___-_--_--_---_------__.--.-_---.-. <br /> ❑ Distance to nearest lot line------------- ---------------------------------------------------------•-----•------•---•-----•--••--•--------•------------•---------- <br /> Remodeling and/or repairing (describe):-----�i0,0-------7-0-------&';NKK7Z- ___0P---------S `,iG',5 "t . ............................................... <br /> ---------------•--•--------•-----------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------- <br /> -------------------------------------------------------------------•------------------------------------------------------------------------------------------.................................................... <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)........--- ............ <br /> '---- --- E------- t`-..-,�d¢:., .r.__ ---------------------------------------------(Owner and/or Contractor) <br /> By:..........s0. ------ ---------------------------------------------------------------(Title)--- --------------------------------- <br /> (Plot plan, showing size of lot, locatt n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ow 51 <br /> APPLICATION ACCEPTED BY- - -- - <br />