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FOR OFFICE USE:..: --------- ---- ----- ---------- - ----------------- � 11APPLICATION FOR SANITATION PERMIT Permit No. ------ -------------------------------------- (Complete in Duplicate) Date Issued T. This Permit Expires 1 Year From Date Issued Application is Eerebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is madeppin compliance with County Ordinance No. S49. wo N yUI I'S If Yl r JOB AQD ESS AND L CATI N--- _6C,KTP_Nz--------RD-----------�-- -------1�-------or=------� -l t Owner's Namje� - `------1-•r-I -T-_ - R. --------------------------------------------------- ----------- Phone,-.----------------- -•------------ Address _ -------�----------- `--------------�- --------- =f ------- -=------------------------------------------------------------------- V4 Contractor's Name--- --------------------------------------------------------------- - ----------------------------------------- Phone----------------------------------- Installation will sere: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ I Number of livi g units: J.-__ Number of bedrooms Number of baths . Lot size ------ACKEff_+►-- -_-_-________________ i Water Supply: Public system ❑ Community system ❑ Private Pr Depth to Water Table R.- ft. Character of soillto a depth of 3 feet: - Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ t Previous"-Applicata�-Made:- H yes,-datd _--. _.. __)-No:.�New'`Construcfir�n: Yesrt o ❑Y- "FNA/1/A: Yes-,�- No-❑,,,, TYPE OF INSTALLATION AND SPECIFICATIONS: "70 110%N AA 13 NN (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest tell Distance from foundation-----`0-------Material. .CON-C-M4_ No. of compartments.__ ----7? -:------Size-fYJP-V- �--__Liquid depth------ Capacity0P"_f_Z_100. Disposal_Field: Distance from nearest well . S- Distance„from foundation-_-.-1� stance to nearest lot line__.__S��f_' � ,..,.,_. - - — tt v1 . t Number of lines-._-_-_----_-�—: .___ __-_Length of each line-s�� +4r . ..Width of french--_.__ rench-- _ ___..._.Of----- ... Type of filter matenal_RO_CJ''N..,Depth of filter material----._t--7------_--_Total length-------------- Seepage Pit: Distance to nearest well------------_---------Distance from foundation------.------------Distance to nearest lot line______..__-____. •, ❑ N'umber of pits-- -.F----------------Lining material-----------------------Size: Diameter.------------- -----_-_Depth---...._-.--.__-.__-----.-_--.._.i— ri Cesspool: DIE,istance from nearest well----------------_Distance from foundation-------------------.Lining material__.,__,.---------.-.----.---____-_. r 1 ❑ Size: Diameter-----'r Depth-------------- ----------------- -----------------Uquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance fromfnearest building--------------------------------------- ❑ Distance to nearest lot fire---------------------------------- Remodeling and7grxr pairing (describe):---------- ---------------- --------------------------------------t'� ------------f ---------------- = `r '�1/ -------------------------------------------- P -- ---------------------- --------•--------------------•-------- -----------------------=--•----- =--------------•------------------------------------------------------�--------- I hereby certify that I have prepared this plication/and that the work will be done in accordance with San Joaquin County ordinances, State laws, and res and regulati hs of`fhe4San Joaquin Local Health District. (Signed)