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APPLICATION FOR SANITATION PERMIT Permit No. 2�------------------ (Complete in Duplicate) Date Issued R Application 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-------- Z-y----- (�h./?m--�'_727/1/---------------------------------------------------------------------------------------------------- Owner's Name--------C 11je '`$ �k ` -------- --------- Phone__'71v� --------------- Address------------- --G(dxt` --- -- Contractor's Name-------- '-. l f.^4' �--- - -- Phone----------------------------------- Installation will serve: Residence W� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___U Number of bedrooms _______ Number of baths ___ ____ Lot size ------ __ _________________ Water Supply: Public system R Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe grHardpan ❑ Previous Application Made: Yes ❑ No e New Construction: Yes eNo ❑ FHA/VA: Yes ❑ No 2�l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well----�-------Distance from foundation--------------------Material------------------------------------------------- No_ of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest we]------------------Distance from foundation--------------------Distance to nearest lot line---------._.____- Number of lines----------------------------------=Length of each line-----`--------------------.._.Width of french----------------------------------- �! Type of filter material-------_-----------------Depth of filter material-----------------------Total length________________________---_-___._--.___- Seepage Pit: Distance to nearest well----_______-----------Distance from,foundation---447___-------Distance d o nearest lothine.,,4–___ Number of pits_____.__----------Lining material./- L_-------Size: Diameter__. _ ___DeptJ________________________ Cesspool: Distance from nearest well_________________Distance from foundation---_---------------.Lining material______.____-_..__-_-____-__________. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----,_---------------_--------------------------Distance from nearest building___-_______---______________________.__._. ❑ Distance to nearest lot line-----------------------------------------------=---------------------------------------------------------------------------------------------- r 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, and rules and regulations of the San Joaquin Local Health District, (Signed)---------------- ` -------- ------------------------------------- ----------------------(Owner and/or Contractor) a � By:------------------------------------------------------------------------------------------------------------------------------------(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-- ---T- .-.R`-0--------------------------------- ---------------------------------------- DATE- - ----------------------------- REVIEWEDBY---------------------------------------------------------------------------- -----------------------------------------------• DATE BUILDING PERMIT ISSUED-----------------------------------------------------------•----------------------------------------_ DATE----------------------------------------------------- Alterations a d/on recommendati ns----------------° 9------------ - ►1 � s !1 - - - t- '- . --------------------------------------------- ------------ ------------------------- -_ .. ----- ---- -�,. �° ...�.f,�------T --.,