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FOR OFFICE USE: I Y V y' A PLICATION FOR SANITATION PERMIT Permit No. - ------------------------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 rhade in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- 4 -�--_- /9'� � _,scl� _�s /I - - - -'�`----------- ----------------------- - - ---------- Owner's Name '. ------ ---------- ----- Phone-•---------•------------------------ Address------- /Ctr--------11--5-1-----------/-- � ------------------------------------------------------------- ------------------------------------ Contractor's Name r Jd.c,/ h--�- ✓�{ ---V' -- Phone---� - :7- _Iplj Installation will serve: Residence P�- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ----- Number of bedrooms -_ __ Number of baths __j--- Lot size --__►r<G 0-.t_,------------------------------------ Water Supply: Public system ❑ Community system ❑ Private E' Depth to Water Table 35�_'_' ft. Character of soil to a depth of 3 feet: Sand E--Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: (If yes,date....................) No ©- New Construction: Yes E- No ❑ FHA/VA: Yes ❑ No n— r __TYPE_ OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) sLC 3 -r�P_. Septic Tank: Distance from nearest well__�___.__._.__Distance from�foundation._.�_ __________.Material_- s.____..::_..-_.....______- .-____---__. 0' No, of compartments------�----------------Size_�_,?X_,�__ e$.__.___Liquid depth_----Y------------------Capacity--- - - -� Disposal Field: Distance from nearest well..-5'- _(--Distance from foundation---/a__-f.-_.-_Distance to nearest lot line-,fir_--_-_--_ ❑� Number of lines---------i---------------- ------Length of each line------�0...............Width of french----2_.1------------------------ Type of filter material___. ?--- ------Depth of filter material----1--V------------ otal length-------------_-_-- Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line__-._---.--_ ❑ Number of pits----------------------Lining material------------------------Size: Diameter-------------.---.-----Depth--.------.--------------_---__-_. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------___.__.__--__-. ❑ Size: Diameter---------------- Depth--------- ------------------------- ----------------Liquid Capacity------------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------.-. ❑ Distance to nearest lot line-- -------------------------------------------- •---------------------------------------------------------- ---------------------- - --------- Remodeling and/or repairing (describe):---- --- /-'--x-------SxZ7.-,�.F+.---....W_ 5 ----�-C------ `f `5 - - o /�-�-------'---- '�'- -------------- 1j/�.:,e --------------------------------------------------- ------------------------ - ----------------------------------------------------------------- c� --------------------------L------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------eAk,, ------------------------------------------------------------ --------------------------------------------------------------..(Owner and/or Contractor) ._ - --By:-- ------`=--_`--------------------------- ----------------------=--------------=-------------(Title)----==---------- _ - ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I --` - - -- -- ------ ------ ---------------------------------------- DATE------ -� -_— �' - REVIEWEDBY---------------------------------------------- ------------ -- ----------------------------------------------------------- DATE----------------------- BUILDING PERMIT ISSUED-------------- --------------------------------------------------------- - --------------• • DATE------------------------------ -- --------------------------- Alterations and/or recommendations:::