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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) 11 <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 /> JOB ADDRESS A�ND/L CATION '06 I-.__-------/ ---------------------------------------------_--------------------------------- <br /> Owner's Name ` -- ------- � - -k -------------------------------------------- Phone------------------------------------ <br /> g - <br /> Address--------_!./ fi - = may - <br /> --------- <br /> Contractor's Name--- -_ a_-_ ---------------------------------------------------------- Phone_- ------ <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> w <br /> Number of living units: Number of bedrooms [I Number of baths [Z Lot size---ZO_ ___________>_�-_�-'__-____----_-----_ . <br /> Water Supply: Public system ❑• Community system ❑ Private K <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ` Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well____ D--- Distance from foundation______-------Material <br /> ______________________________________�f_____. <br /> No. of compartments------------- ----------Capacity--- QD _--Size----r Yr_ - _�r_��_Liquid depth------sY---Z---------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> 0 Size: Diameter-------------------------------------Depth---------------------------------------------------- <br /> .Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.------------------------------------------ <br /> El Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---- <br /> ___________-_ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------ <br /> Field: Distance from nearest well----_ -"Distance from foundation____Zd-'-----Distance to nearest lot line___43�f___ <br /> Number of lines____________y-� Length of each line---------7X__-______-Width of french--------Zw-' <br /> Type of filter mater:al_�•L--____/Y_ ___Depth of filter material_______��______ <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------- <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, <br /> State <br /> /laws, and rules anc[ regulations of the San Joaquin Local Health District. <br /> (Signed)---'s- .—.A..----- -- -- <br /> -------------------- ---------------------:-- ---- -------(ow" <br />