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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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. 549. JOB ADDRESS AND–LQCATION-------------4r.9, --- e-----L .�I LJ�s-.� ---------- -----------------•------------------ Owner's Name jQ +� ----------------------------------------- Kone--- --- Address------------- --Address------------ j�'------------------- Contractor's Name.. `Cd. Q1?.tG.l� --------------------------------------------------------------- Phone................................... Installation will serve: Residence F] Apartment House F-1Commercial E] Trailer Court F] Motel ❑ Other [� Number of living units: -0-__ mber of bedrooms -----10 Number of baths _9--_ Lot size ___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table... __ ft. �f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No IA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tanks Distance from nearest well_________________Distance from foundation--------------------Material ______.______.___._____._____..___.__._________ �� Vo. of compartments-.__-___ _,�„__ ___Size________________________________Liquid depth------------___.____;--___Capacity Disposal F' Id: Distance from nearest we11g�Distance from foundation../_/- .Distance to nearest lot line._5..f_.__. [ Number of lines-------------I-------------------Length of each line___,J_ 1-------------Width of.trench-:__aP_Y_'�._...______..___ Type of filter material.__>r ._! ____._Depth of filter materia!___.1_a.__--___.Total length.__,.3$-__________________________ Seepage Pi : Distance to nearest well___�Q .Af—Distance from foundation_./d../._._..Distance to nearest lot line�__�_-___-. Number of pits------.-_/______-Lining material_.,i✓OG __.Size: Diameter____J3---_.__Depth----a0_________ ___•__- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.---------------------------------- . ❑ Size: Diameter ----------- Depth ------•---------------- ------Liquid Capacity-----------------•---------gals. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building-_-__.___________-__-______-_____.-.-__-_-- ❑ Distance to nearest lot line nn s e r . Remodeling and/or repairing (describe)--------------00413,•�q�- ,rer ._._. ------------------------------------ ------------------------------------------------------------------------------------•----•---•--------------------------------------------•--------------------------------------•---------------•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an es nd re ions f the San Maquin Local Hea District. �.---- (Signed)__________________------------------ ----- -----,•�_ ___(Owne�and or Contractor) BY: - -------(Title) t�--- ---- - ------------------------- (Plot plan, sh g siz f lot, location of system in relation to w dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------- -------------- ----------------------------------------- DATE---------------------------- ---- `= REVIEWEDBY ----------------------- - ------------------------------------------------------------- DATE----------- ---- BUILDING PERMIT ISSUED------------------_------ - � -----I-------- DATE ''' ----- ------------------ --------- Alterations and/or recommendations:__-.- -__ --- ---------------------------------- ._----- --------------------------------------------------------------------------------------------------------------------------...........-------- ------------------------------------ -------------•-••----------------------•------ ------ --- �"" FINAL INSPECTION BY: ...__- ------------------------ Date.. .-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.