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FOR OFFICE USE: �� ------------------------------------------------ ------.-- APPLICATION FOR SANITATION PERMIT• Permit No. -------------------------------------------- --- (Complete in Duplicate) �P DI -------------- This Permit Expires 1 Year From Date Issued ate 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. C?C,0 3 ' 2,:kv-69 5 - JOB ADDRESS AND L CATION__.___ .<il -- _-__________ ____ ___ -��------- /� Owner's Name--------- d,--------- ---- a --------------s ------------------------------------ Phone------------------------------------ Address-------�Y.92-------- ---•-------- ------------ --• s Contractor`s Name------ :,/Lt� _: �_ �, �/ ----------------------•r------------------------------------------ Phone----- -•------- ------------------• , Installation will serve: Residence 9?( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living _ ______ Number of bedrooms units: d 3__ Number.of baths j_____ Lot size7d�-/�� ________________________._ 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 ❑ 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 200 feet.) Septi ank: Distance from nearest well---r4?---.---Distance from foundation----1 ___Ma er-ial----- _ D.-_ Na. of compartments_------- ----r-------------Capacity_-SizeT_ � -Liquid depth. W �J p Df 1®___11--___Distance to nearest lot hne�f � Dis os Field: Distance from nearest well-_�___._'_._Distance from found tlon-__- _.___________':, Number of lines----_ 44 Length of each fine ^7 s - � WVldth of trench_.-Z-___-_ Type of filter mat _ -- -filter materiW- erial-__ -- - Depth _---� -f--�- -------Total ----------------------- _______Distance from foundation________________ ___ _ Distance to•nearest-lot liner___. ----------- _ Seepage it: Distance to nearest welL_-._______._ L � ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------:---------------Depth_ --------'---------------_- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------- • !__-_-________ ❑ Size: Diameter--------------------------------------De th_--------------------------------------------------Liquid CapacitY-----------�- - ------__-gals. I A Privy: Distance from nearest well___----------------------------------------_-----Distance from nearest auilding--------------` :-----------------_...... !' ❑ Distance to nearest lot line------------------------------------------------------------------•-------------------------------------------------------- ----------------- ! Remodeling and/or repairing (describe):--------------_____________________ P1 ---- -----------=---------------------------------------------------------------•--•---------- ----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------•---•--------------•-----------------------------------------------•-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with rSan.Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------ ----------- -- ---------- :Mwn and/or Contractor) _ BY- _ _ ----------=------ -----(Title)---- •------------------ --_-- -- -_ (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side).- FOR ide)._FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--;r�,f'', ----------------------------------------------------------- DATE---