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FOR OFFICE USE: - ------------ -------------- ---------------- -- - APPLICATION. FOR SANITATION PERMIT Permit No. .- /_.- ---------------- ------------- --------------- ------- i (Complete in Duplicate} " . Date Issuedl--��-----.G --------------------------- 1 This Permit Expires 1 Year From Date Issued 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. ......... --- --------- --------------------------------------------- Owner's Name -------------- --------------------------------------- ---- - Phone-.y6--� ---•- Ca Z Address--------------- --------------------------- --------------- ---------------------------------------------- ------•-----•------------------------ Contractor's Name------- -------------------------- Phone.'�!��._---- yz' ------------------ - --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - Number ofbedrooms -_oz Number of baths --4- Lot size ---------------------- Water Supply: Public system ;f Community system ❑ Private ❑ Depth to Water Table �la ft. Character of soil to a depth of 3 feet: Sand E] Gravel F1Sandy Loam ElClay Loam ElClay E] Adobe Hardpan ❑ Previous Application Made: (If yes,date------------ -----) No ❑ New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well---------------------Distance from foundation--------------------Material -----_--.----.---------------------.-.-.--- ❑ No. of compartments. -----------------Size -------Liquid depth--------------------------Capacity-•-------- ------------ Disposal Field: Distance from nearest well------- ------Distance from foundation----- .-----------.Distance to nearest lot line----------------- 0 ❑ Number of lines------------- ---------------------Length of each line---------------------------- Width of trench Type of filter material-------------------------Depth of filter material-.-..--.-- Total length-----------------------------------l----- )2 ,, _e --- Distance from fo ndation---2--S..-_...Distance to nearest lot line--.S-------. Seepage Pit: Distance to nearest weIL.�WC' - Number of pits'-------Z- ------Liming material-' .Size: Diameter--.-- ----Depth-------- - Cess ool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--------.-..--..-.------:__-_-..-- P ------------Liquid Capacity ---gals. 40 ❑ Size: Diameter--'-- ---------------- -------- Depth----------------------------------- t -Distance from nearest building Privy: Distance from'nearest well - 9------------------------------------------ Distance - Distanceto nearest lot line.---- --------- --------------------- ------------------------------------------------------------- 1 ' Remodeling and/or repairing (describe):---------------- -•------------• ---------•---------•-------------------------- ----------------------------- - ----------------•-••----------------------------=----------------------- ---- ---------------------------------------------------------- -- 1 ------------------------------------ ----------------------------------------------------------- -------------- - -- - ---- -- ---------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and re5julations of the San Joaquin Local Health District. IV Owner and/or Contractor) (Si ned)--------------------- ---- ----- - - ---- ---------------- -- ----