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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / � 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 LOCATION.__._. /r 'r 2------ �a.2 r --- -- raw Owner's Name = 1_x:,5::__ _ N----' ��W �� " __ Phone--- -------------------------------- Address z �- <d ------'------------------ Contractor's Name----I------------------------- ,47 -�.--------------------------------------------------------------------------------------- Phone--------••--------•------ Installation will serve: Residence4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._)-_ Number of bedrooms y_ Number of baths __ Lot size ------------------------ --____-.S'� C----a-3 � Wafer Supply: Public system�j/ 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. Yes ❑ Nox New Construction: Yes ❑ No FHA/VA: Yes ❑ N0341< TYPE OF INSTALLATION AND SPECIFICATIONS: 1 e (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I w______.Mat'e!rial---- ` Sep Tank: Ni. of from nearest well------ --------- ------- izeJce foundation uid depth---------- Q______ ,# No. of com artments---------________ _ _____Size________ . I t Disposal Field: Distance from nearest Distancewell___-`-_____._. from undation_-_V- �`�:___.Distance to nearest lot line____ Number of lines_____--_____ _ - - each-L&nqC-of-each`line_______-___�__�___ _WOWidth of trench._____._-2___��_______________- Yp pew F T e of filter material______ --De tN of filter materna!___--_. _______.01'o�fia'I"-length_______________ '_ _- 5eepa Pit: Distance to nearest well_______='__—______Distace from foundation_____ ___-_.,Distacfe to nearest lob line _____ , . Number of its--------_I-----_-Linin material_____-f�''� Size: Diameter____3_.�_..________Depth_-__...___�- ---------------- Cesspool: ----------`- Cesspool: Distance from nearest well__________g__.__Distance fromfoundation-------------------Lining materia -------____------- ❑ Size: Diameter---- ---------------------------------Depth-- -------- -.----- ---------------Liquid Capacity---------------------------gals./ Privy: Distance from nearest well__________________________________________-- ____Distance from neares# building--i_________________ ❑ Distance to nearest lot line- ---------------------- -------------------------------------------- Q _ �u Remo eling and/or repairing (describe :_ ___ I ------------------- -----------=--------------------------- -------------------------------- - ------- -�----- '/3`3---�—"----------' --,� -- ------------ •-•---------------- N ^ ` ---___ ---------------- �J--- t _ -' ------------ - � . g I hereby certif that I have prepared this apr 'a io� a d that the'work will'be-do e n accordance with San Joaquin County S ordinance5, State ws, nd rule nd regulat'o of he San Joaquin Lo,*l Health District. I 1 (Signed)/---------- ----------