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APPLICATION FOR SANITATION PERMIT Permit No. .- d_Z__.._ (Complete in Duplicate) U Date Issued ___- ,f��" Applica4ion 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. i ft JOB ADDRESS AND OCATION--- 1-:/ 7 �" � ------- ------------------------------ Owner's Name------- Phone_ p_' --0 ).2 � -------------------------------------- Address. ° 3 --------- I '` ------------------------ ------------- ------ ---------- ---**------------------- Contractor's Name----00 ------ -------- -- ----- � -----�-----= =j' ------- ------- - Phone_&P.'_�.^_f Installation will serve: Residence [ErApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms _`A_-__ Number of baths J___ Lot size Water Supply: Public system ® Community system Z Private ❑ Depth to Water Table ________ ft. 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 A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic Tank: Distance from nearest welt______—_______Distance from foundation------- `SI_____-Material-_,____ ® No. of compartments------2--------- Size X "------------Liquid depth-------�_ -X � ---------Capacity_.._`l_ o------------ _ _ Disposal Field: Distance from nearest well------ ------Distance from foundation-----:°-._____.Distance to nearest lot ® 42 Number of lines_____________ f_- -------Length of each line -7�--�r-------Width of french_____-�Y_f __- ' Type of filter material-------- _T-----------Depth of filter material_____ _ ______Total length _.__'�___ �- T_` Seepage Pit: - Distance to nearest well________`-__--_-Distance from foundation__...��__r__ ,QC.a ' to to nearest lot line______��__` �. ' Number of pits.----------/---------Lining material__�`_'_e_- �ize: Diameter___- - --------------Depth__-_ N, Cesspool: Distance from nearest well-----------------Distance from foundation------------------_.Lining material---------------------- --------------- El _-_______--_---_____________-_-_ __❑ Size: Diameter--------------------------------------Depth----------------------------------- - --------------Liquid Capacity- --------------------------gals. �. Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building---------________________-- Distance to nearest lot line------ -- ------------------------ ----------------------------.... Remodeling and/or repairing (describe):-------- -------------------------------------------------------------------•-------------------- •---------------------------•------- ---------------------•-----••------------------------------------------- •-----------•---------------------------------------------------------------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, anQ r les and regulations of the San Joaquin Local Health District. (Signed) By: . ------ --------�----t-—— -- ------------------------------------------------------------------(Owner and/or Contractor) ------------------------- -- -----------(Title)---------- ------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- ---------------------------------------------- ---------------------------------_--- DATE REVIEWEDBY -- ------------ ---------------------- --------------------------------------------- DATE-- ---- ---•----------•-------------------•-------- UILDING PERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE--------•---- ---------------- A terations and/or recommendations:-------------------------------------------------------- ----------------------- ------------------•------------•--------------------------- ------------.----------------------------- ----------------------------------••- ----------------------------------------------------------------------------------------------------------------------•------- -------------------------------- ---------------------------------•-- ---------------------------•---------------- FINAL INSPECTION 8Y:_