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FOR OFFICE-USE: -----------------------__ _________________ ________--_ APPLICATION FOR SANITATION PERMIT Permit No. ..12.�A a ------------- -------------------------- ---------- i (Complete in Duplicate) 7 Date Issued --------- ---- - This Permit Ex0 ires 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..t -21 JOB ADDRESS AND CATION- - f/ .�Cl th � - ._ :w------------------------------___-.__..------------------- Owner's Name______ _____ _ Phone �-.tet: _ __ C_ c.�------------- ------- ...---------------------------��--- Address ` 4 Contractor's Name F / �s� ' ------ ------ ------------------------------- -------------- Phone. = . .. Installation will serve: _Residence Apartme' nt'House ❑' Comm ercial'❑-Trailer Court ❑ Motel ❑ Other �] i Number of.living units: _" _._ Number of bedrooms __��_____ Number f baths "" Lot size __.___7ry- �?c.a _--_____•__ _____ 1 Water Supply: Public system ❑ -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 ❑ Hardpan El 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.204 feet.) Septic ank: Distance from nearest well-------5-!e___.__Distance from foundation___-A---_____.__.Material"-..____Qe.,______ No. of compartments-____.2_____________Size .l j , ` quid depth--------f --...____.._._Capacity_____-- I? Dispo Field: Distance from nearest wefl.__5'p....... Distance from foundation -_.Distance to nearest lot Number of lines-__.""-- _ _, Length of each line_____, -------------Width of trench------_�Z_-___-------------------- — Type.of filter ma tergal____ __.-_ Depth of filter.material___,1_,f_Fr______Total length--------- -- - ----_1 N r 5ee/paeit: Distance to nearest well------ ------Distance from foundation______f t?_._.___.Distance to nearest lot line_-5'__--_--_._� i Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Dept h-_____.__._______" I In Cesspool: �� Distance from nearest well----------------- from foundation___._.____-_-_--_-.Lining material__.__-____________________ ❑ Capacity 'Sizer_ e: Diamet _ . Y--------------------De th------------------------------ - - _Liuid Caacit Dept --- ---------------- q P Y------------- - ----------gals.) - Privy: Distance.from nearest well---------------f'------------------------------ Distance from nearest building4 Distance to nearest lot line_------------ -------°------------------- ---------- ,. V Remodeling and/or repairing (describe):------------- ----------------------------------- - a - ; ---------------------------------• s -------------------------------------".----------------•----•--------•-------•-----•---------.-----•------------»-------------------------•--------...----•-------•-----------------------•-------------------------- 1 hereby certify that I have prepared this application and that the work will done in accordance with San Joaquin County �- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. EI - ------- ------------------(�or Contractor) BY•-----------•- -- --------- -------- --- _ (Title)