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APPLICATION FOR SANITATION PERMIT' Permit No. -_,�.................... ... (Complete in Duplicate) Date Issued Applica}ion 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 Ordinance No. 549. JOB ADDRESS AND LOCATION------ _- - .._.2--u- -IJ-0 q Owner's Nam - ------------------------ a� — t A � �.__ €a� � 1 Q.__` ---•--------------------p----------------- Name Sl f�.�-'1� Y14r�- h ---------------- Phone .! _I_!F?a Contractor's ------------- Installation will serve: Residence [,-partment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living unifsi __./_ Number of bedrooms .-7,-'Number of baths j--- Lot size ------------------------------------- Water ------Water Supply: Public system [7" Community system ❑ Private ❑ Depth to Water Table :eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ .Clay ❑ Adobe Hardpan ❑ �-►. Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e tic Distance from nearest well-________________Distance from foundation--------------------Material______.____".___________...______-----------_.__. No. of compartments-------------------- --Size--------------------------------Liquid depth-----------------------_Capacity----------------------- sal FW . Distance from nearest we€1---.--------- -_Distance from foundation_____________:.__.."Distance to nearest lot line___________-_-_-_ Number of lines----------------------------------Length of each line---------------------------.-.Width of trench.------------------------.--------- Type of filter material-------------------------Depth of filter material---._.__. ._ Total length___.._._..______________._____.__-....___. I- ------ � 11 + i veto nearest lot line-45_- Seepa �t: Distance to nearest well-P--------------Distance/f�m` l°undation__ _.. _____ .___ S Number of pits--f------------------Lining material-- ----.Size: Diameter---- --- -----------Depth-_�Sr----------------- Cesspool: Distance from nearest well-----------------Distance from foundation___---------_-------Lining material__ ____.______.___.----_.__.__._____- ❑ Size: Diameter ------- ------------ -------- ------Depth--------------------- ------ ------------------- -.Liquid Capacity- -------------------------gals. 1 n Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.---------------------------. V 1 ❑ Distance to nearest lot line------------------ --------- ------------------•---.- -----------------"--"---------------------------------------------------------------- Remodeling and/or repairing {describe):..--. • ----------------------------------------------• ------------•---�- -- --------------- ---------------- ----------------------- ------------v_ •-----------•---••------- -------------- ---------------------------•---------------------••------------------------------------------------------------------------------------------------ ------------------------------------I——----•------•----------------------------------------------------------------•-----------•--•------- --------------------------------------•----•------------•----------- I hereby c i that I have prepared plication nd that the work will be done in accordance with San Joaquin County ordinances, Sta la s, and rules and reg a ons of t n Joaquin Local Health District. (Signed)_ ---�. . ------ --------"--- -- ------ -•---- ---------------- - --- -- ----- ontractorJ B (Title)_ ' (Plot plan, showing size of lot, location of system in relation to w s, uildings, c., can be p ed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- ----------------� ''r .......... ------ -•-----------••----------- DATE........ r-�----------- ----------- - REVIEWEDBY------------------------------- - ----------- - --------- ------- ---------------------------------------------- DATE------- --- ------------------------------------------- BUILDINGPERMIT ISSUED------------------------------- -- ------------------------------------------------------------------- DATE.-------- ---- �, ---------------------- Alterations and/or recommendations:--------------- ----- - - -----------------•--------------•--------•-•-----------------------•-.----- ---4-- ------------------------ ------------------- ---- - 1 Y4 -1 -- -1---- ----------- -- -------------------------------------------- ----------------------- ---------------------------------------- -- - ------------------------------------------------------------------------------- ---------- ----------------- FINAL INSPECTION BY:-"