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APPLICATION FOR SANITATION PERMIT Permit No. ._.! U <br /> f (Complete in Duplicate) <br /> / Date issued ---- <br /> OApplication <br /> This Permit Ex "fres i Year From Date issued <br /> is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Or finance No. 54-9. <br /> JOB ADDRESS AND LOCATIONS �E <br /> Owner's Name-------!�� L ---------------------------------------------------------------------- Phone------------------------------------ <br /> Address---------------�--•-- <br /> Contractor's Name----- T <br /> - <br /> Phone <br /> Installation will serve: Residence Ug—'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: /___ Number of bedrooms _.2— Number of baths __/_- Lot size !�C ✓ _ _ ________________________ <br /> Water Supply: Public systemR[1­Commuriity system ❑ Private ❑ Depth-to—Water Table%M_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @g--Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No.,Wj—FHA/VA: Yes ❑ No 5;— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> Septic Tank: Distance from nearest well-- -------------Distance from foundation----------------------Material______.---__-_--------______________________- <br /> No. of compartments----- - _ _-------Size----11---------------------- -Liquid depth--------------------------Caacit <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- <br /> Type of filter material________________________ <br /> Depth of filter material-___.________--___ ----Total length___------------------------------------------- O <br /> Seepage Pit: Distance to nearest well__-�^____._____Distance fr foundation +�+0_-_______-Distance to nearest lot line---Cs7 (� <br /> Number of pits-------- Lining material;___ f Size: Diamefei.......73.*-----Depth ;ZJ—*----_____.._ <br /> Cesspool: Distance from nearesf well_________________Distance from foundation_:_-________.._____.Lining material_-------:____--_-__.____.____._______- � <br /> ❑ Size: Diameter--------------------------------------Dept h-----„--------------------------------------------.-Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildina---------------------------------- <br /> ❑ Distance to nearest lot line---------------------------- ------------•-----------.......-.------------------------ <br /> s <br /> Remodeling and/or repairing (describe):_-------------- -------------------------------------------'-----------------------------------------------•---------------- <br /> r <br /> - ------ ---------------------------------------------------------------------------------------------------------------------------------------•-••----------------------- ---------....----------------------------------- <br /> --------------------------------------------------------------------------------------- k -------------------------------------------------------------------------------------------------- --- - - <br /> I hereby certify that I have prepared this application and that the woi <br />