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FOROFFICE USE: <br /> --------------------------------------------------------- <br /> _______________________________________ ------------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------- ------- ------------------------------- -------- (Complete in Duplicate) <br /> ........ This Permit Expires 1 Year From Date Issued Date Issued /l_�_✓� - -� <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 i h County Ordin ce No. 549. <br /> J08 ADDRESS AND OCATIO ---------------------- <br /> N_- -- . <br /> j Owner's Names . _ �C 7'� Phone <br /> Address_____ <br /> ----- -• - ----- <br /> ------ - -••------------------------ ---------- 7�- <br /> ---------------------------------------------------------------- <br /> Contractor's Name ----•-------------------•---•--------••------------------------ - ------------------------- Phone-•----•----•---------------------- <br /> Installation will serve: Residen ff❑ Apartment House ❑�,/Commercial ❑ Trail Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---L_-_ Number of bedrooms _1!__- Number of baths __ __- Lot size —___s <br /> Water Supply: Public system E] Community system ElPrivate x Depth to Water Table __ ft. <br /> Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> 4 Previous Application Made: (if yes,date________ __________1 No p New Construction: Yes No ❑ FHA/VA: Yes ❑ No'F� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank,or cesspool permitted if public s7wer is available within 204 feet.) <br /> Sep ' Tank: Distance from nearest wellP_.___Dis#an fro at' ' <br /> - - -�-�•-----_.Mafi real -- -- - <br /> ,� No. of compartments------ _ Size. - Ljquid depth-------- __. <br /> Disposal field: Distance from nearest well _/..-_ .__Distance from foundation- .-----Distance to nearest lot ine_/_�_ <br /> Number of lines__ - �- Length of each fine_ / (Width of trench___ <br /> Type of filter material�_�__ �epth of filter material_.___/_ --Total length__1_ep-:--------------------- <br /> Seepage Pit: Distance fo nearest well----------------------Distance from foundation--------_-----------Distance to nearest lot line_-____._--_-_--_ <br /> ❑ Number of pits---------------=----!Lining material-------- -_----------- Size: Diameter-----------------------Depth--------------------------------- <br /> r Cesspool: Distance from nearest well---------------__Distance from foundation----------------- Lining material______________________________________ <br /> ❑ Size: Diameter- ------------------- - -.---------Depth-------- ------------------------- -----------------Liquid Capacity--------------------- --gals. <br /> Privy: Distance from nearest well-- ------------ --------- _____ Distance from nearest building__-__---____----_ <br /> ,,❑ Distance to nearest lot line'-' = <br /> Remodeling and/or repairing (describe)----------------------------------------------- -----------__-_-- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- <br /> ----------------------- ----------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la and rules a reguF ' ns of the an Joaquin Local Health District. <br /> h , <br /> (Signed)___ _ <br />