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f � <br /> y s� APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application 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 /> - `�� 1 � ---- =-Y f------------------- ---------------------------_-----------------------=---- - <br /> JOB ADDRESS AND LOCATION-A-1957,2 /y <br /> Owner's Name---------------- f` 4S "-------le�Z- -W-----�tt----- Y;-,p_D Prone-�---/717/---------=---------------- <br /> � <br /> Address-----------------1_4!� + ------VIk4d, tt����!-�---/------ ---------"------•-------------------•------------------------------------------•------------------ <br /> Contractor's Name ' 1� ! / _C7_ -s _O__ i r = Phone. -- lP.d __rte, <br /> 1� ,�- <br /> ent House Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Installation will serve: Residence % Apartm ❑ ❑ <br /> 1 f <br /> Number of living unitsOM$ Number of bedrooms /_____ Number of baths f-__-__ Lot size _ "D ____ -� ------------------------- <br /> ;W r Supply: Public system ;k Communi-y system ❑ Private ❑ Depth to Water Table.-417 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ElClay Loam ElClay El Adobe Hardpan E] <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! <br /> i <br /> Septic Tank: Distance from nearest well-�3�--.-_-_---Distance from foundation_, Q__________Mater'�k__ QIC - L�-------------- <br /> Y 11 �_______Size � 1�� '--_0_sLiquid depth `�--------------Capacity_�p4__�� �. \ <br /> No. of compartments___._ _ . <br /> Disposal Field: DisTance from nearest well_ Q.____.__.Distanee to nearest lot line_ __Q________. <br /> �Q_________.Distance from foundation.-2-.49 <br /> g ;F--------.Width of trench �� <br /> Number of lines-__!.a hie-________________Length of each line____ <br /> # Type of filter materiallf r�l�fl �G___Depth of filter material___ -_,._-_.___Total length___-__7__�________________________ <br /> 1 <br /> rest well____,________________Distance from foundation____._______..: _ <br /> ____.Distance to nearest lot line________ . <br /> Seepage Pit: Distance to neaw. <br /> ❑ Number of <br /> P pits t_ _ ---Lining material-----------------------Sze: Diameter------------------------Depth------------------_------------ <br /> .__________ <br /> I { <br /> # from foundation______.___.__.____.Lining material _____________. <br /> Cesspool: Distance from nearest well____________ <br /> F1 Size: Diameter-A------------ ---------Depth----------------------------------------------------Liquid Capacity-------------------- gals. <br /> I ----_Distance from nearest building <br /> I ❑ Distance to nearest lot line------------------------------ ---_------------------------------------------------------------------------------------------ <br /> Remodeling an /or repairing{describe) -------------/•-[ <br />