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X1 �51113 1 APPLICATION FOR SAN � ITATION PERMIT Permit No. _._._`v L_7 �"� (Complete in Duplicate) V Date Issued --- -y/_!_�,S Applical-ion 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 LOCATION-"-_----Ld .Z._ .10' Owner's Name ------ -------- - --L----------------- - - --------------- Address ------...... . .----- -- ?� ------- --- --------------------------- ---------------- - --- -- ------ -- Contractor's Name_-"_. .. _s._._� - -- - �� - - --------------- Phone. -- ---------------- ---- - -- -- - - nstallation will serve: Residence Apartment. House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._._. Number of bedrooms ._ _.. Number of baths _ Lot size __._".-_.gip Water Supply: Public system ---`"-"'X'��`---------------- PP y� y b4 Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay ❑ y Loam lay Previous Application Made: Yes El No 91 New Construction: Yes El No El ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: , Distance from nearest well-----------------Distance from foundation--.--_ ❑ As,1 IV No. of compartments--------- ----- --------------Material-----------------------------•------------------• �--�---------Size----- ---------------------Liquid depth---------- ---------------Capacity----------------------- Disposal Field: Distance from nearest well----AlomrDistance from foundation. r Number of lines------- _ _ ��---------•Distance to nearest lot line.,�(�_�___- PQ ��-------------Length of each line------c-A,�"" Width of trench___ _yr�!-_ " Type of filter material__�5,.- �k`"Depth of filter material-_-.-_� 1------_Total length".---.o,� °'__ Seepage Pit: Distance to nearest well----//Q-t/ff---Distance from fo_undation.Number of pits--------/-----------Lining material--__ 4 _ S'-----• Distance to nearest lot line-__ -4X_ Diameter _- -----Depth_.__ 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-__--_-_______-_.__.-_-_ _ Remodeling and/or repairing (describe):-------- ------------------------------------ ____________ ------ ---------------•------•---•-----•---------•-----------------•-------------------------------------•-"----------------------------------------------------------- --- -- ---- ----------- U I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , and rules regulations of the San Joaquin Local Health District. (Signed)-____:..._ _ By;______-•- -and/orContractor) caner a d/o Title Pot plan, showing size of lot, loca+ion of ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ ------ ----------------------------------------------------------- DATE REVIEWED BY -_ BUILDING PERMIT ISSUED--------- DATE - -