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rUKvrn mac <br /> / LIGATION FOR SANITATION PEF Permit No. <br /> T Date Issued _. _! <br /> -.....— <br /> ------------- ------------- ...................... (Complete in Du licate ..----.'.. <br /> --------- ------------ ---- ----------------------- This Permit Expires 1 Year From Date Issued <br /> LApplication 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 /> JOB ADDRESS AND LOCATION-------------ff 6lA�+i[��d.---------------••--r---------.._.-------•----------.._---....-•------••_---•-•--- <br /> Owner's Name............`-r--d----_ull.�i/J�.tt!L/...--_-•----y--.`-.---------'-------'.-----------------`•------•----...--------- Phone......--_._..._:.............. <br /> Address--------------------------------------ay.�.9140------/- --`�-/--�-i---6-t-L/!t!-. --Anl......-_...__._»..-----•-•--------......_._-_......._.....--_...._.._ <br /> Contractor's Name---- `-••------------ -L-�'-*....... -------------....---------------------------•---- -'--------- Phone.............................. <br /> Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑s Other ❑ <br /> Number of living units: _-J_ Number of bedrooms _-Zi Number of baths J.... Lot size ....6Qm ------------_-.._-___—....... <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table n'�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sen y Loam [I Clay Loam ❑ Clay❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No [RNew Construction: Yes 0- o ❑ FHA/VA:Yes ❑ No 9-� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_...Distance from foundation--lo_-_------------ ................ <br /> 91_ No. of compartments---------Z-----------Size--------Sl�?X`/.-Q---Liquid depth__--.��Z-...----.---Capacity.-..".L._.__ <br /> y <br /> Disposal Field: Distance from nearest well......':�.Distance from foundation.--4071.......Distarice to nearest lot line... <br /> Number of lines------------------ ...........Length of each line_-___------rf_0............Width of french.....921.................... <br /> ` Type of filter material.-- -%a -.". -r-Depth of filter material-.. ----Total length........... _-----------_ -- \ <br /> Seeps It: Distance to nearest well.....--=---Distance from foundation_-110--__-___.--Distenre to nearest lot line-. ...---..- <br /> 19 Number of pits......1..............Lining material.._I1r.4a-s.utSize: Diameter..&3----.........Depth.... ................. <br /> Cesspool: Distance from nearest well.................Distance from foundation..............------Lining material................................... <br /> ❑ Size: Diameter------_----------------------------Depth........'.......... ------------Liquid Capacity--•---•-•------------...gals. <br /> k. Privy: Distance from nearest well.................................................Distance from nearest building-----------.-_-___.-__._.--........... <br /> ❑ Distance to nearest lot line--....................---------------------.......----------------__---------- -------------------------------------.............. <br /> Remodeling and/or repairing (describe):.......:__-.-..--. ..�e4 ----- <br /> - -'---.................................................------------._---------------- ----------•--•----------_-------.................. ----------------•----------------------------- <br /> ------------------.. - ----------- ----------------­ <br /> f hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed........-.._-4eAd1--- _ ="'!r-=! <br />