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APPLICATION FOR SANITATION PERMIT Permit No. ----- --------- <br /> v 3 <br /> (Complete to Duplicate) Date {sued ___A2/ � <br /> Application is hereby made to-the San Joaquin Local Health District fog a permit to construct and install the work herein described. <br /> pp ce with County Ordinance No. 549. <br /> OCATION-_ <br /> This application is made m comp ian + <br /> ,.� o �' <br /> JOB ADDRESS ANA � ---' -- - -- - -- <br /> R ` ---------------------------------------------------- <br /> Owner's Name------ _./� <br /> 11. 3 ----------------- <br /> Phone <br /> . <br /> Address--------- ' <br /> ►`. Phone <br /> Contractor's Name---- ...... <br /> Installation will serve: Residence A�Plrtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/----- Number of bedrooms __Number of baths _l.___ Lot size .__ _________ --__ <br /> Water Supply: 'Publ ic'system ❑ Commu6ity system ❑ 'FnvateAQ_Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand"❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction:-Yes 0_ No ❑' FHA/VA. Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_ �Q Distance from foundation____ _t..__.Material____G�_ .- ---- <br /> ,,.. g• Capacity--- <br /> No. <br /> rl0 '� iFeia <br /> partments-----a----------------Size_,�r' -X � id depth �� Capacity ------------ <br /> � � � <br /> f <br /> Disposal Field: Distance from,neare'st well ' -.Distance.from .foundatioD ��---.----Distance to nearest lot line__ ___. <br /> o. o <br /> " <br /> _ Length of`each line_____ �3�FWidth of trench_-______.__��_.- <br /> Number of lines-----:-��---`---� 9 ` r J --- -------- <br /> Type of filter material__l�r___ /Q Depth of`filter material---- _g_._____ g <br /> Total length c? <br /> . .:, <br /> Seepage Pit: Distance to nearest well_.-�-A-Distanee f om foundata ___ _�_�--.Distance to nearest lot line_.._ <br /> Number of pits------- <br /> ------Lining material_ Fr�r�eter �.`�_.Depth <br /> s <br /> Cesspool: Distance from nearest wel -----------------Distance from foundation_--._.___--_- Lining materia <br /> --_-__- l-__----.._.__-----_._-_--..--_.-----. <br /> t ❑ Size: Diameter-�------------------ -- ------Depth-------------------- ---------- ----------------- Liquid Capacity- -------gals. <br /> r <br /> k Privy: Distance from nearest well------------ ----------- - ------- --_--__Distance from nearest building---------- ------------------ -----� <br /> ❑ Distance to nearest lot line-"----------------------- ----------- -----------------------------------=----------------------------- <br /> t - <br /> Remodelin and repairing (describe):---------------------------9------------------------------------------•-- ------•----------------•----------•-------•------------------ •------ <br /> g .. ..... ---------------------------------------- <br /> ----------------------------------------p g ----------------------•-----------=------ <br /> t , <br /> \ � <br /> I hereby certify have prepared this application and that the work will be done in'accordance with San Joaquin County `�' <br /> f ordinances, Stat -laws, rules and regulations of the San Joaquin Local Health District. <br /> z j j.t Owner and/or Contractor <br /> (5 ne �-� 1 -- I � T,tie <br /> ------ ------- ----- <br /> -- <br /> - -------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. <br /> I FOR DEPARTMENT USE ONLY ;yJ <br /> .�. DATE------------------ <br />