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FOR OFFICE USE: ---------------- ---- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _.. � .Q. ---------------------------- (Complete in Duplicate) Z/ Date Issued -----.--- This Permit Expires 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. S49. JOB ADDRESS AND LOCATIONV--- '�` .----------- Owners Name..... �L 09 - ��------P0j_ tD_EX_-7 ------------ 4 'Aq Phone._ _... r ( i Address- - .. .fit--------- -----�------- ---- "� _C `�'--------•------------•------- -- Contractors Name ::�/ �-t- --' P.4- q-'-)... -----••-----------• Phone.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 1 Motel ❑ Other ❑ Number of living units: _ ---- Number of bedrooms 3. Number of baths -_-----_ Lot size .-.. .. --- --•1-��d Water Supply: Public system �Communitysystem ❑ Private ❑ Depth To Water Table -.._ .. ffi. Character of soil to a idepth of 3 feet: Sand Gravel E] _ Sandy Loam 0-Inay Loam ❑ Clay ❑ Adobe❑ Har n Previous Application Made: (If yes,date--------------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No€� --TYPE'OF'INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r----.-Dista a rom f dation.--- _®_ Ma a ial ._ f �T Septic ank: Distance from nearest well----- --._. _ �� 4? -----Size./---,&--- - ---- Liquid depth Capacity No. of compartments--___-��___ �- -� =-- 71 Disposal field: Distance from nearest well-.-'.-----Distance from foundation___.j0...--.Distance to,:mearest lot li�je___---5 Number of lines------------- ------------------Length of each line----:---- Q Width of french.--- --�1l�r ------ 44 �i f I Type of filter material._9_0_C4_-C-- Dep}h:•of•filter matenal.-1 ----------Total length--------�t-0--�-----------------•-- Seepage Pit: Distance to nearest well---------------------Distance from foundation----._-------------Distnceto nearest It line--.._---_--.._-._ i ❑ Number of pits---------•------------Lining material-----------------------Size: Diameter---------------------- Depth----------•----------..-..------- I 1 i Distarice from nearest well---------------�Distance from foundation------ material_--.---.-..__--------------------- Cesspool: .. ❑ s. Size: Diameter----------------------------- [Depth-==--------------------------------------------- ,fl_iquid Capacity-------•=x----------------gals. ' Priv Distance from nearest well t--------------------------------Distance from nearest�uilding-----.-------t-------••----------------- C� - '=------- Distance to nearest lot ling---------------� ----------------- ---------- ---"�-----..._�__. ------ Remodeling t � , - ..- ,} ----- -----• Remodeling and./or repairing (describe) � - t ---..- - ---•--------••---------------------------------------------------- ---------- ------------•-----------------------------------•---- ----------- --------------------------•--- l - y--�----------------•— --------------------pp-------- ---------------------4=---,__.----•-•-` ----------- ------------------------------------------- I * -------••----------- I hereby Artif that l have prepared this a lication and that the work will be done in accordance _, ance with Sen Joaquin County ordinances, State laws, and rules and r a ons of the San Joaquin Local Health District. 1-1 F. I r.;