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Permit No. ._�C--5 .5 <br /> _ APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued ___; ''-•- •� <br /> Joaquin Local Health <br /> Applica{ion is hereby made to the San h District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordin ke No. 549. � <br /> f I f p }� ---------- <br /> j} <br /> fU-( <br /> JOB ADDRESS AND L CATION___.----{ I <br /> ----------- -- -------- -- ------ -- ----- - Phone------------------------------------ <br /> Owner's Name---- --------------- -•------------- <br /> Address---------_____ <br /> -•+•--f-- •-• -----------------------i=-- -- ---------- a <br /> - -------- Phones <br /> _ a )---�--��-�--� <br /> • 1� p --------------------•----------- <br /> Contractor's Name____ C? -- <br /> Apartment House ❑ Commercial F1 Trailer Court ❑ Motel E] Other ❑ <br /> Installation will serve: Residence ® p <br /> _ -1 d J----------------------- <br /> Number of living units: --1___._ Number of bedrooms __ 'Number of baths "�--- Lot size __-___ ___ ___ <br /> Private ❑ Depth to Water Table. ft. <br /> Water-Supply: Public system ®, Community system EllAdobe Hardpan [ICharacter of soil to a depth of 3 feet: Sand ❑ Gravel F1 ❑Sandy Loam Clay Loam ❑ Clay [D <br /> Previous Application Made: Yes ❑ No-[& New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Dist nce from nearest we}l_------_--------Distance from foundation-----------_-------.Material-____---______p____�--------------------- <br /> Nof compartments------ Size Liquid deP}h Ca aci <br /> Disposal Field: is an from nearest well_______ _________Distance from foundation________--______---Distance to nearest lot line___-_________---" <br /> 1 um �of cines--------------------- ------------Length of each line------------------------------Width of trench <br /> Type of filter material____--------------------Depth of filter material -- <br /> -----------------------Total length_-__________---------.-------------------- <br /> Seepage Pi+: 'Distance to nearest well_.../Y 'Distance from oundation__---�_--_.__..DistaR�e to nearest lot iine,�""- ----- <br /> e -?--------------Depth----�_c.----- <br /> r Number of pits-------- ------------Lining material.------__- -- - <br /> : Diameter___ <br /> �.. <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining materia _ <br /> _-._________- __.____--_____ ._--___ <br /> _Ls uid Ca acit gals. <br /> ❑ Size: Diameter----------- ------ -------- --------Depth------ ---------------- -------- ------------ q P Y------ ---------- -------- <br /> ' -------"---Distance from nearest building------------------------------------------ <br /> Privy: Distance from nearest well-------------------------- <br /> ❑ Distance to nearest lot line-------------------------___________________ <br /> ----------------------------------------------------- <br /> ------------------- <br /> -------------------------- <br /> Remodeling and/or repairing (describe):----------------------------------- ---------------_---------------- <br /> ------------------------------------------------- -I-------------------------------------------------------- <br /> --------------------------------------------------------- <br /> --------------------------------•------------------------------------------------------------------------------ --------------------------------- <br /> i ! hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Statel1iws, and rules and regulations of the San Joaquin Local Health District. <br /> Si ne r and/or Contract <br /> }— ----------------------------------------------------- (O d/o <br /> e <br /> = <br />