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APPLICATION FOR SANITATION PERMIT Permit No. ...`.....s... /( (Complete in Duplicate) �� Date Issued ._:�_� _�Z_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install�he work herein described. This application is made in compliance with County Ordinance No. 549. ff JOB ADDRESS AND LOCATION f ' - 1•�� - _ `,_: -- Owner's Name �, ± ' ------ --- - - Phone ----------------.------------- -------------------------- Address = ---------------)-0 ------- Address------------------- - -�----�---- - - � -----_--------------------------------------------------------------------------- Contractor's Name____________________________ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Others❑ Number of living units: 1____ Number of bedrooms _Z-_ Number of baths _/_:-_ Lot size .�_ __3 ___-:_---_-___--__-.____ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 44t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No �rNew Construction: Yes 2"INo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__5 ^Distance from foundatjon_./A_-*' Material r_ '_Si :-_-__-. No. of compartments-------� ______-._-Size---- __ __?� 5, Liquid depth------ ----------------Capacity.__Z,077 _ Disposal Field: Distance from nearest well'5 7Y'� °Distance from foundation-_/_Q__ Distance to nearest lot line---- of lines-- _ Length of each line_______y__ ® 9 = Width of trench ---------------- Type of filter material_Sr ___ _, =Depth of filter material__- -__-______-Total length_-____---_, Q-._______________ __ 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):------ ----------------------------------------------- } --------- -------------------------- ------------------------•--------------------------------------------------------------------------------------- ------------------ ----------------------------------------- ---- - i 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 ar`d regulations of the San Joaquin Local Health District. s i / R Si ned ------- -- - ------ -----------------------------------------------------------------------(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). r- F D A ;