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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> ------ 1 <br /> --------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------------- {Complete in Duplicate} Date Issued __�`-Y � <br /> _._..----------------------------------------------------- This Permit Expires 1 Year From Date Issued l <br /> Application is hereby made to the San Joaquin Local Healfh 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 AND LOCATION.-4 ------T <br /> Owner's Name------ - -1 -� � � N J�--------------------- - - ----- ---------------- ---------------- Phone-r/ _ _ -; --`7 <br /> Address---------------��.... <br /> Contractor's Name- - <br /> ame ' /__.aS =�{1C'.. --------------------------------- Phone __".%rl� � <br /> Installation will serve: Residence Cff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �a <br /> Number of living units: __1--- Number of bedrooms _X,_ Number of baths __f_. Lot size7't, __________________�Water Supply: Public system E] Community system ElPrivate X Depth to Water Table ---� <br /> Character of soil to a depth of 3 feet: Sand [R Gravel E] Sandy Loam E] Clay Loam ElClay obe ❑ Hardpan. <br /> Previous Application Made: (If yes,date.-__.______________) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No <br />- --YTYPE-•OF,INSTAL-LArfION AND SPECIFIGATIONS:��- " - - - ---- --T-'�• <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__ . ._`___ Distancr frFm fo-undation_�_6-. _ __.Materral_ � <br /> ____----- <br /> 10 <br /> UK _ sfNo. of compartments _ �--------------Srze_71 _�J -- ---------Liquid ---------Capacity_/AW - / <br /> Disposal Field: Distance from nearest well-----------------Distance from founclr�_- _24nDistance to nearest lot line_----------.----- i <br /> 5d Number of lines-_- __ Length of each line_^Width of french----C?A. _.._ _____.______.- <br /> Type of filter material-- �_-_Depth of filter material_. 6 __._.__Total length__ T'.-------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearei lot line-----ri R_�• <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------- <br /> r <br /> ---.___--- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material-----------------------------._.._.__ <br /> Size: Diameter------. ---- --De th------------------ ---------------------- ----------Liquid Capacity gals. b• <br /> Priv Distance from nearest well-----------------------------------------------__Distance from nearest building <br /> ❑ Distance to nearest lot line... ----------------•----------------------------------- <br /> Remodelin and/or repairing (describe):____ <br />