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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No./. .�1f.... ------------------------------------------------- --- -- - (Complete in Duplicate) Date Issued 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 LOC &L� ... TI N_______. �., ___ __c__ ._ -------- -_---- f � J / �- -------------- Owner's Name---------------- ---------- ------------� •- - -- •-------------- -------------------------------------------- Phone------------------ Address > -�� - .��----------��V ---------------------------------------------------------- Contractor's Name---------------------------------- ----------------------- --------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms __rz�._ Number of baths -------- Lot size ___ Q__ /.,_lf______________________________ 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 9 Clay ❑ Adobe ❑ Hardpan C3 Previous Application Made: (If yes,date--------------------) No New Construction: Yes [91'*/No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,p Septic TVk- Distance from nearest well_- M1 Distance�frop found_ton-_.��_- .�-----Materia _4r_ ' ____i No. of compart ._ ---------- Liquid de th._ � Capacity -&Z DisField: Distance from nearest weell.l �-f Distance from foundation-----A.e___Distance to nearest lotfine-__,pNumber of lines7 _- _. --------- --------Length of each of trench.---__�--------/--------------- Type of filter material- , _ _ ._ Depth of filter ma.terial____.f_ l�-------Total length---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material----------- -----------Size: Diameter-----------------.-----Depth----------------_--------___- Cesspool: Distance from nearest well-----------------Distance from foundation------:-------------Lining material--------:---------------.___-_---.--_ v ❑ Size: Diameter------------------------ ------ -----Depth----------------------------- ------ ---------------Liquid Capacity----------•----•------------gals. Privy: Distance from nearest well------------------___------------- --------------Distance from nearest building-------__.-------------------.-----._..-. ❑ Distance to nearest lot line--- ---------------------------------------------•--------------------- ------------------------ -------------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- -----------------------------------------------•---------------------------------------------------------------------•--------------- -------------------- ------I------------------------------------------------------ ---------------------------------------------------------•---------------------- --------------------------------------------------------------------------•-----•------•-------------------------------------------------------------- ------ V -------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------- 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 andnregulations of the San J quip Local Health District. ` /"J f/ (Signed)----------- l4 _ � �'