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FOR OFFICE USE: \ .___--____________________._____.__-______-_._.._ APPLICATION FOR SANITATION PERMIT Permit No. -�a1-_-4. l ------------------------- --- �}� (Complete in Duplicate) Date Issued fV2'!7___ � ---------------- ----- ----.Y_-�- - --------- --- 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIO .....31,?Z b.__ .-_ ................... ........ Owner's Name_ _ 1/- �'4'r'h zJ__..,� 7 ( Phanef.f_.. Address ----•->. z..rf�s�------------•----------------- Contractor's Name.- d . Phone -------•--• •-••- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [�— Number of living units: __ _t___ Number of bedrooms -------- Number of baths-------- Lot size _____ ___ ________ -------- ------__________________________ Water Supply: Public system,B- Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe ErlHardpan ❑ Previous Application Made: (If yes,date------------------- ) No L'J New Construction: Yes ❑ No [5 FHANA: Yes ❑ No 2, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Distance from nearest well_________________Distance from foundation-------------..-----Material ._..------._.-----_._--__.________.._..__-_-._-. No. of compartments------------- ---------Size......... --------- -----------Liquid depth------ ----- ------- Capacity.......... -------- Disposal F',F' Id: Distance from nearest well-------------Distance from foundation__-�v-_.._.____-.Distance to nearest lot line......... �,,q/ Number of lines_-.-___/________________.-------Length of each line_- ----.__-3z'-------------Width of trench--2-1--------------------------- \1 Type rench_'z1-__.__.--_-_-___-____--- Type of filter material'76-4_ _-----..Depth of filter material.-l3-----------------Total length----3!2-_`______________________________ Seep g P' : Distance to nearest well ._.-----Distance from foundation---��----------- Distance to nearest lot line----- O Number of pits-_.L____-_-----._-Lining material. 4S ------- Size: Diameter__- .._-Depth---------8--------------------- Cesspool: __................. Cesspool: Distance from nearest well ----------------Distance from foundation-------.------.-- ..Lining material----:-------------------------------- ❑ Size: Diameter- -- -------- ----- --- - - --------Depth--------------- ---------------------------- -------Liquid Capacity-------------- ----------gals. Privy: Distance from nearest well----- ------------------------------.-.--------..Distance from nearest building----------------------------------------_ ❑ Distance to nearest lot line---------- -------------- -------------------------------------- -------------------------------------------------•------------------- Remo eling and or repair•ng (describe _1.. _.___ tt1__ _._______._b..___ __________________ car ✓ �> � --- - ,� ✓ ��-�c� ----•------- ---•------------------------------------------------------------------------------- - ------�- -------- ti------- -----------••------ ------- ------ ---------- -------------- --- - I hereby certify that I have prepared this application and tha the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) y /� �---------- -------------------- -----------------------•- ---------------------------------f9ma -3lswor Contractor) BY: o!