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FOR OFFICE,USE- ----------- -------------- �_ -_________________ APPLICATION FOR SANITATION PERMIT Permit No. ��.. ... ----------------------------------------- --- -- (Complete in Duplicate) . Date Issued --------------------------------------------------------- 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 Count� a ce�iVo. 549. JOB ADDRESS AND LOCATIOV----- - T/ R-!>-----------:V.... ------.Alrc_., Owner's Name-------------------- l;.60�-------- ------ Phone----------------------------------- Address - jT .... ' �T L------------------ ------- -------------------------------------------•------------------- - ----- Contractor's Name--------F:ULL a_ ----------------------------- - Phone -------------------- Installation will serve: Residence [!Apartment House E] Gemmercial E] Trailer Court E] Mootel Other ❑ Number of living units: ---1--- Number of bedrooms _.'`'Number of baths �------ Lot size . Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 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-_---------_--_.--) N0,21"'. o, ;New Construction: Yes 2?"N"o ❑ FHA/VA: Yes F�'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-If public sewer is avaitable within 200 feet.) Septic Distance from nearest well__�W----Dista�cf��ff om fou on___/0--------.Materi i--.C_ ^fC_R�TE-_--_. No. of cpmpartments----- ------_---_ Y�I,!'OX Liquid depth_- __Capacity_/;4 0-�__ Size._ .__._. Disposal Field: Distance from nearest well_ ....Distance from foundation----/ ---------Distance to nearest lot line... ...... 99--- Number of lines___._.__2 _- ----------------Length of each Iine_!V_S_- 065—_-Width of trench----71?--__ir--------- Type of filter material_/ —A -.Depth of filter material---.--t _.____..Total length.............. __--------___-- Seepage Pit: Distance to nearest well-------------__-_.---Distance from foundation--------------------Distance to nearest lot line-----.--._.._--._ ❑ Number of pits.----.----------------Lining material----------------------Size: Diameter--_------------------------Depth-----.------------------_.----_- Cesspool: Distance from nearest well ------Distance from foundation--------------.----Lining material-_.---_---._----_.-_---.-.--____-- ❑ Size: Diameter--------------------- ---------s------Depth--------------------------------------------------Dquid Capacity--------------:-------------gals. Privy: Distance from nearest well _-- ------------------------.------. -Distance from nearest building-------------------------------- El .. .- --❑ Distance to nearest lot.line---------------------------------------------------------------------------------- ----- - ---- --- - - ------- --- Remodeling and/or repairing (describe):----- - ---- - -------------------------------- ---------------------•------ ------ •--- ---------------------------- 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 and regulations of the San Joaquin Local Health District. f. (Signed).. ----------------- (Owner and/or Contractor) By--------------------------------- ------------- -------------- ----- - --- --------- ------------------(Title)---- ------ (Plot plan., showing size of lot, location of systei