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FOR OFFICE USE: <br /> -------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . . z --. <br /> - --------------------- ---------------- -- (Complete in Duplicate) 3 - �j-U t <br /> i - Date Issued ----------------------- <br /> This Permit Expires 1 Year From Date Issued <br /> Application 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 Ordinance o. <br /> �JOB ADDRESS AND L T ` - - -------------- <br /> Owner's Name....------ ••--------- --•-------------------- ---- Phone-------------------------------_- <br /> Address---------------------- <br /> -------Address---------------------- .. . -------- L- -- - '- -I. _= = -== ------------------------------ <br /> Contractor's <br /> - <br /> .. x <br /> Contractor's Name------------------ -- - '- Phone----•--•...._-.....'-----.-..._-. <br /> Installation will serve: Residence partment-House ❑ Commercial ❑ Trailer Court ❑ Motel+❑ Other ❑ <br /> Number of living units: ..__ Number of bedrooms .�`-. Number of baths -I..- Lot size rl_ Il -----•____________________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ <br /> Previous Application Made: [If yes,dote------------------- No D40'4* New Construction: Yes (�lo ❑ FHA/VA: Yes Pi to ❑ <br /> y; <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:t <br /> (No septic tank or cesspool permitted if•public sewer is available within 200 feet.)` <br /> Septic Tank: Distance from nearest well__ - Qis#ancrom foundation. - Mat r' I__- - --- <br /> �� No. of compartmenfs:-_-d�---- ---,--Size. /'W--------- depth----/ .`.___-r-..Capacity--- -�t ---.._. <br /> Disposal Field:. Distance from nearest well___.-.-"--.-._Distance from foundatio ._-.l _---_---.Distance to nearest lot lit--�_- <br /> [ Number of lines--------- <br /> `__ ____ ____ ______ Length of each line___-- Q i Width of trench.----�------_.--. -.__----- (a <br /> Type of filter material- pmaterd� r <br /> ---_�+De th of filter ial_---� ---.-- ._Total length----__Frl: -f....................... <br /> Seepage Pit: Distance to nearest well___--_-----______--Distance f m fou dation_-_--�t�._..--.Dis nacre to nearest I$� line_-._----_.- <br /> Number of pits-----�-------------Lining material_ Size: Diameter._LY..�-.-.._._-- p vz <br /> Cesspool: D;sfance from nearest well-----------------Distance from foundation--------------------Lining <br />' ❑ � _ - - material <br /> ter,i,al_ <br /> --.----.__----_---_-_----------.__.. <br /> Size: Diameter------------ --- <br />