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FOR OFFICE USE: <br />----------- <br />- <br /> -------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> ------ -- ------------- Date Issued -- �f/t/7.� �_. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein descririb <br /> ed <br /> This application is mad in compliance w'th County Ordinance No. S49. <br /> SIAL <br /> JOB ADDRESS AND LOCATION..----•------- - _� -D fLCr - <br /> , Name________________ <br /> D NA_F�?---------------------=----------- -------------------------- <br /> Owner's --------- Phone------------------------------------ <br /> Address <br /> Contractor's Name.---------QR '-------4 Phone----------------------------•----- <br /> ----------------------------------------- <br /> Installation will serve: Residence ZApartme tt House ❑ Commercial [I Trailer Court E] Motel El Other <br /> 1 Number of living units: _t7--____ Number of bedrooms-4-_ Number of baths _1_--_ Lot size ------- <br /> - =r <br /> Water Supply: Public system ElCommunity system ElPrivate Depth to Water Table__--_-__ ft. <br /> Character of soil to a depth of 3 feet: Sand Q Gravel ❑ Sandy Loam ElClay Loam ❑ lay E] Adobe E] Hard i 11Previous Application Made: ;If yes,date-------- ] No New Construction: Yes, <br /> No E] FHA/VA: Yes" No ❑ <br /> TYPE:OF INSTALLATION AND SPECIFICATIONS: ___ _ <br /> --I ermined if u... sewer is available within 206-feet.) <br /> {No septic tank or cessp p p <br /> Septic Ta k: Distance from nearest well__S0_______Distance from foundation__.__ ______.Mat rias__.__ea tR r=-T�- -- <br /> No. of compartments_____.._-_ __...__Size,5�1./_Q._X-57 Liquid depth'_--- Y--------------- <br /> --- _----_-Capacity <br /> Disposal Field; Distance from nearest weld__-!SQ_----Distance from foundation_.`0______.-- sfAce to nearest lot Ilnef��? <br /> Number of lines---------I-----------------------Length of each fine--------, ----- <br /> .-"WE:dth of trench.----_ --- --------- <br /> Type of filter materiai__ C -----Depth of filter material__:_ :"_ _-_-Totallength___________ _________`-'+ 0. <br /> Seepage Pit: Distance to nearest well--------__________._Distance from foundation____________________Distance to nearest lot llrne--.___.____.__._ —� <br /> Linin material_-_____ -- Siie Diameter_______________________De th_ t <br /> ❑ Number of pits----- ----- ✓ ng111 p <br /> Cesspool: Distance from nearest well--------le_..__Distance ram�foundation_____________ ____Lining material__._•.__. __ :___-- .� :________ <br /> Size: Diameter_ k° J th .....----Liquid Capacity------- -------------gals. 0 <br /> Privy: Distance from` n-ea=rest:40_--------------------------------------_ __ ---Distance from tea.r-estbuildi-ng-_ _____._______--------. <br /> Distance-�tolnearest lot line---------- -------------- ---------------------- -------------• --------- ---------------------------------------------------- <br /> -4. <br /> ------------------ <br /> �driring <br /> a. <br /> Remodeling an ,/or reIdescribe):____--F-K15Tj NC-----,_��5_TQM------F £ ------I�f1.T <br /> =s y r- r�------- +� �T,< c----`FV-------D vF-A--�.�.v ---------- � -- �. <br /> ... , <br /> -------------- <br /> I-hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ord'tni <br />