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FOR OFFICE USE: <br /> _ Permit No: I-f-'-`~•'��--"-1--- ' <br /> ---- -- -----------------------�____-..____ "_-__ APPLICATION FOR SANITATION PERMIT <br /> --- .- -_ - -- (Complete in Duplicate) �j� Date Issued = - <br /> I This Permit Ex ires 1 Year From Date issued <br /> ------- ---------------- `- <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 No. 549. <br /> t <br /> ° ' <br /> JOB ADDRESS AND LOCATION. �+'�4 "d '�"'. "" "" -- <br /> r.- <br /> Phone}------- -----------•-------•--- <br /> Owner's Name ff////}}. i 1 <br /> Address = t -----•-------- <br /> Phone..------••---------- <br /> -Contractor's Name-------- 3 <br /> }' Motel Other ❑ <br /> Installation will serve: Residence [Apartment Nouse ❑ Commercial ❑ Trailer Court ❑ ❑ <br /> Number of living units: ..___ Number of bedrooms __'2�lumber of baths __.o___ Lot.size _ -----------•-- <br /> <? � ' <br /> fWater Supply: Public system F1 Community system ❑ private to Water Table ft. <br /> dobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam Clay Loam [IClay ❑ A ❑ <br /> Previous Application Made: {1f Yes,,date_----_.__-,--------) No ❑ New Construction: Yes E] No E] FHA/VA: Yes ❑ No El <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I Septic Tank: Distance from nearest well------------------Distance from <br /> foundation- Material------ _- <br /> quid depth - Capacity______:__ .________.-- <br /> No, of compartments---------- ------------- Size-------=------------------ <br /> ❑ r <br /> Disposal eld: Distance from nearest well40'_-¢ "-Distance from foundation_._.lc±--"-------Distance to nearest to tline____J�"_____.- <br /> Number of lines-------------1--------------------Length of each line--- /-Qa ----i-- Width of trench---- -- ------- <br /> i - ----Depth of filter material ""__l -,--------Total length------- -fJa-------------------------- <br /> :Type of filter matenaL_____�__ .._ �- , <br /> I Seepage Pit: Distance to nearest well___________________--Distance from foundation------.-------------Distance to nearest lot line____--_.______-.- <br /> Number of pits----------------------Lining material---------- Size: Diameter- Depth_ <br /> Cesspool: , ,eDistance from nearest well_____------------Distance from foundation-------------'------Lining material------------------------------------gals. <br /> Depth ---- --------Liquid Capacity" <br /> ❑ Size: Diameter--------------------- ---- p <br /> I Privy: Distance from nearest well---------- "-- -- ---------- <br /> ____.-Distance from nearest building.----------------------------------------- <br /> E] Distance Dista_nce to nearest lot line_______-------- _t-- <br /> I ----- -----------------------•--- •------- <br /> Remodeling and/or repairing (descrlbe): :- =------------------------- <br /> 9 ft ------------- <br /> _________________"______________._______________. f .________-____________ __________-____-___.__-.._____ <br /> ------- -------------------------- <br />