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FOR OFFICE USE: - - -� J3� t . APPLICATION- FOR SANITATION PERMIT � Permit No. _._t.............--... ---------------- :• -- (Complete in Duplicate) _ _ �!—I�- is 11 Date issued -------:----•-••------- „- ..__ _ 1 -----=-------- - -„ !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 hereiri desciribed. This application is made in compliance with County Ordinance No. S _ a JOS ADDRESS AND L ATIO _ .7/.v----- _ -- - - 1�-i---------• 'vv't'` -- Owner's Name - Phone - = ---------------------------------------=------ Address--------- j ----•----•-----------•------------------•--•-••----- ---.---------------•------------_----•-•-------------.------•------- Contractor's Name-_---'�� ` '' Phone t Installation will serve: Residence g?--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i do / Number of living units: Number of bedrooms___.Number of baths ?-,"--,Lot'size _ ____________------------- '. Water Supply: Public system ❑ Community system Zie"Frivate ❑ Depth to Water Tablet_ Character of soil to a depth of'3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe iardpan ❑ Previous Application Made: (If yes,dote--------------------) No R5.-,New Construction: Yes ®/IQo ❑ FHA/VA: Yes P--_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A Septic Tank: Distance from nearest w . l___` Distance foundation___`-________.Mata�al_ ler_ ______________ No. of compartments-_ --------------- eri+dk,' .��"Liquid depth-----�-_-_-_-_ p y-- 5iz . ---- -------Ca acit /��--- i Disposal Field: Distance from nearest well.... .-.-_Distance from foundation----/149__ ----Distance to nearest lot line__,_--__ . �y (� Number of lines______-_:oZ___. Length of each line__-_!' . --__ ------.Width of trench__,Z_#4______________'._--_._# .01 Type of filter material��_Depth of filter material_-_/�__-_______Total length___ . .______________________ F Seepage Pit: Distance to nearest`well-____-- - -_---�Distance fr m foundation___,�P�__-_.Distance to nearest lot iine__s��_-- p -_, Number of pits___-�+-----------Lining material-_ � _-Sze: Diameter.s�3_____________De th4�.-___________-_---_-.--_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------..------------------------------- El __-_____-______- __-_____❑ Size: Diameter----------------------I---------------Dept h------------------------------------------_----------Liquid Capacity- ----------------------;, 9als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------.-------- Distanceto nearest lot line----- -------------------------- -----------------------I---------------------------------------------- ----------------------------------- Remodeling and/or repairing (describe: -- - • - - -----•----------------------•----- . -----------••------------------------------------------------------------------------- --------------------------------------•--•----------------------------------•--------------------- - f - --------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I 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. St ned ------ --- ------- ------- ------ ---------�Vor Contractor) (Signed)