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f <br /> APPLICATION FOR SANITATION PERMIT Permit No. -------!___-?.-1----- <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica{ion is hereby made to the'San Joaquin Local Health 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..--C-2Z--C_/----L-E. 1�-- ---------- -------------------------- ----------•------- - icy----`� ---------------- <br /> Owners Name -------- P�` "e <br /> Address--------------------- -a"'. -'---------------------------------------------------------------------------------------------------------------------------------------------.-----------•----- <br /> Contractor's Name------ -------------------------------------------------------- ---------------------------------•-------- Phone----------------------------------- <br /> Installation will serve: Residence 0_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel <br /> Other ❑ <br /> Number of living units: __.I___ Number of bedrooms _t____. Number of baths ._l1__ Lot size ._4d----_f\__10_Q------------------------- ; <br /> Water Supply: Public system jjT Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gHardpan ❑ <br /> Previous Application Made: Yes ❑ Noo New Construction: Yes 9�No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material--_--_--__-________-____-_-_-_---____-----____. <br /> ❑ No. of compartments- ------------------------Size---------------•----------------Liquid depth----------- --------------Capacity---------------- ----- <br /> Disposal Field: Distance from nearest well-'.-.'h_DZ4..Distance from foundation-----1'Gp---------Distance to nearest lot line______-�Z..... <br /> Number of ------- <br /> -------Length of each line-------- --------------Width of trench__ <br /> Type or filter material-_ x- -—611�bepth of filter material------/___P_______-_Total length--------- _CQ_________________________ <br /> Seepage Pit: Distance to nearest well.'-----__-__-_----_-Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of pits______________________Lining material------------------------Size: Diameter------------------------Depth--------------------------------- <br /> Cesspool: Distance from nea!r�st well k0A-*~,Distance fro foundation...1-0--------Lining material-__. ______ <br /> Size: Diameter-----it---x ----- ------------------- --- -------------Liquid Capacity-- Y' ---------ga S. <br /> Privy: Distance from nearest well-------------------------------------------- ---Distance from nearest building----_------------------------------------. <br /> ❑ Distance to nearest lot line--------- --------------=--------------------- ---------------------------- --------- ------------------------------------------------------ <br /> Remideling and/or r�epairi�g (describe):--- .-._--__ - -ate"--- ------ �•---- ---f�---1-----• -- - ---- •- ------ <br /> ------ <br />