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--------------------------------•......A............ ________________ APPLICATION FOR SANITATION PERMIT Permit No. _f-�`. ..... ........................................... -1 (Complete in Duplicate) .................. r From Date Issued Date Issued .�1....1 - ------------------------------------ ---------------- This Permit Ex rres 1 Year 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 cgs pli-ance with County Ordinance No. 549. /_ATHR0 F>` JOB ADDRESS AND LOCATION_ __ _till__:-._Avot4------ -.__ / T _l Q- ---- -------(------------------�o.-........51-r......... Owner's Name------ ----------- ----------------•----- ------ Phone....................._------------- Address........ rii` ` ,� ------c7.7 -------------XA T�klRpf------•-----------------------------------•-•--•------------------------- Contractor's Name------0_w �...............•--------------------•---•-----------------•-------•--------•-••---------._.._....----•----- Phone.................----------------- Installation will serve: Residence @T Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1____ Number of bedrooms '9-- Number of baths j... Lot size ...,/- ---X... ..................... Water Supply: Public system ❑ Community system,Private ❑ Depth TO Water Table .......- ft. Character of soil to a depth of 3 fe'et.,,#San dR2/Gravel ❑ Sandy-Loarr Clay Loam ❑ Clay.❑ Adobe ❑ Hardpan ❑ :^;; Previous Application Made: (If yes, - _)-NY 03"_"New'Constructioni'Yes-UEr No'❑` -FHA/VA: Yes [:1 No �-y TYPE OF INSTALLATION AND SPECIFICATIONS:' F � (No septic tank or cesspool permitted if public sewer is 121abliwithin 200 feet.) I Sot-T nk- Distance from nearest well--=___.-_Distance fir ifoundation__�5�------ .Materia!- No. of compartments-------- —_ depth Capacity- - --- Disposal `'Q•-.•-.. T , Field: Distance from nearest well.--T= Distance fr}om1foundktion.--1 O________Distance to nearest I t ---=-- -------- ____Length each line,5 ". Width of trench.-_- Number.of lines_________ f Type of filter material._.? C.K__Depth of fil�te*material_.__- P`___..__Total length................ .I ..�...___..__.. 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 from1foundation_-------------------Lining material---------- ..__._._-__....._.. ...... ❑ Size: Diameter----• -•------------------- ------Depth----4 -------_-----•--- --------------------Liquid Capacity----------------------------gals. Vj Privy: Distance from nearest well-------------------------------------- _ .._____Distance from nearest building______________________________.__.__-___-. ❑ Distance to nearest lot line------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------- ----•-------------------------- f --- r-- i -----------------..........•----•-------------------------------•---------•-------------•-•------- ----------------------•-... •-•-••-------------•--------- ------- It --------•-•------------•--------•--------------------•-•----•-------------- "" [� .� I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule nd regulatto S of-the tan Joaquin Local Health District. (Signed) - :------•--------------------------- � ----------------•------------------------- ----- -- ----(OWner and%qr Contractor) By:-------------------------------------------------- - Title (Plot plan, showing size of lot. location of system in relation to wells,-buildings,,a+c.j•canabe placed on reverse side). -��--1.,_ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____.- .R•I2!------------------------------•-------•---------•------------•--•----- DATE---- r � ..�:7 ------------------ REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE--------------------------------•------------------------- BUILDING PERMIT ISSUED---------_-_-- ':- ", -^----•-• === ' `''- `' ' ' DATE. --------------------------------- Atterations and/or recommendations:_-._______.___..