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FOR OFFICES USE: --- ------------------ ---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ................ ..:� , ---------- ------- `' (Complete in Duplicate) >-' Data Issued --------------- --1�'--_� ------------ ---------------------- -------------------- This'Permit Exires 1 Year From 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?. 5)49. JOB ADDRESS AND LOCATION-- ------- / ----------'�-` ...4_�1J -- --------•-----------_-------------------------•-------- Owner's Name-----------I(A-�-l'.�_�_�_-2F:?;-e"=,�r�• ----- - •-----------------•------------- Phone----------------------------_- Address ----------•------ ' -- -------------------------------. ----.. Address---------------�_- - ------- =1. L� ,� s ---------------------------------------------------------------------------------------------------------------- Contractor's - ---- -------------- Installation ---------- Contractors Name--------.--- =�ri' �"�,r /' --------------------------------------•--•--------- --------•-------- •--..... Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of bedrooms Number of baths _Z_ Lot size ... ---------• Wafer Supply: Public'system ©Community system ❑ Private ❑ Depth to Water Table .1 ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe©Hardpan ❑ Previous Application Made: (If yes,date---------------------) No 0' New Construction: Yes ❑ No [D'' FHA/VA: Yes ❑ No [g— 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-----------------Distance from foundation___________________Material-__-_-.__-_____-_____-._____-_--._-_-__.-_-_----- 1 f(4f No. of compartments--------------------------Size--------------------------------Liquid de th--------------------------Capacity... Disposal Field: Distance from nearest well-----------------Distance from foundation------_____---------Distance to nearest lot line..-.____________- E. !! I❑r//N� Number of lines-----------------------------------Length of each line------------------------------Width oftrench----------..-..--------------------- Type of filter material____-________________---Depth of filter material-----------------------Total length___-____.__-----_______.____-_._______--__ �. Seepage B: - Distance to nearest well-------- m fo ndation----l,Q_'_-_..Dista Distance to nearest lot line_--- -�___ 5l! Number of sts._____ __ Linin material___ _ Size: Diameter_____ ___ __ p �� b� P �---------- 5 Depth r.2s Cessp"oo"I: Distance f;•om nearest well------------------Distance from,foundation----________._i--__.Lining.-material----------------------------------- -_. m E71 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): C /-{. - _-------------------------------------------------------.-------------------------------------------------------------------- J _______________________________________ .____-_____-_______.__ __--_______________.__________---_________..____..-_.____________.-__ ____..._________-_-______________------___-_...-_-._____.___-._-____.------.__-_.___-__ I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and relations of the San Joaquin Local Heath District. �� ----- ---• ------------------------------------------------(Owner and/or Contractor) (Signed)•------------- rte/ By:-------------------------------------------------------------------- ----------?f---- �- --------------------------(Title}==- �1/= (Plot plan, showing size of lot, location of system i lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENVUSE ONLY APPLICATION ACCEPTED BY--------- -.--- ----- REVIEWEDBY-------------------------------------------------- ------------------------------------------------------------------------ DATE------------•---------------------------------------------- BUILDINGPERMIT ISSUED---------- -------------------------•------------------- ------------------------ ------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---