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ev �1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) I 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 Or nce No. 549 JOBADDRESS ANDVC TIO ---------------------------------- -------------------------------------------------------------•-- Owner's Name-----/-- - - --------- -•----• - - ---------/-------------`-------------------------- -------------------------------------- Phone----------------------------------- Address------ ---------------------------Address------ --------4 -- -------- ' g -- - �------------------------------------------------ ------- ------------ Contractor's Name____________________ q_ _ f�1J Installation will serve: Residence ('Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms j__ Number of baths /__ Lot size ......�_"o-�_1_--_a-Q___-------------------- Water Supply: Public system e"C"ommunity system ❑ Private ❑ Depth to Water Table 50�rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No 9;---New Construction: Yes ❑ No [9---MA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is nk: Distance from nearest well_________________Distance from foundation------------------..Material___________________-___-:__._---____-__._______-. No. of compartments-----------------------�r__Si e---------------------------:---Liquid depth--------------------------Capacity------------------ == Disposal field: Distance from nearest weIIQ_�!�i"`t"'stance from foundationQ .Distance to nearest lot lin _`. Number of lines_-________�_______ _ ______ -Length of each line__--�'d__----------------Width of trench---.?-__ __ 47 --------------------- Type of filter material_,_ __ _ Depth of filter material____,�9-__-_-____Total length__________________r�d-------------- e Distance to nearest el �__ _Distan m f ndation._.4Q__.�_.___.Distan to nearest lot line_ �__. �' Number of its______ ______________Linin material..- ___ ___ ___Size: Diameter_____ _ _ _______-De th_-___ __ ______-_____ (_, p g r�3 p _v Cesspo Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- EJSize: -----------------------------Liquid Capacity--------------------------gals. ize: Diameter--------------------------------------De th------------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________-_______-_____-________________- ❑ Distance to nearest lot line - Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------(------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- I hereby cer ' t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws a d riles and reg lations of the San Joaquin Local Health District. (Signed) f �� --------------- ------------------------------n -(Owner and/or Contractor) By:----------------------------------------------------------------------��4 ---j%