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R APPLICATION FOR SANITATION PERMIT r (Complete in Duplicated 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 Ordinann+ce� No. 549. JOB ADDRESS AND LOCATION-------- _a______S_______l � �_ OwnersName----- K_ �'` , [ -----------------------------------------------------------`---------------------------- Phone-------w------------------ Address .......?�Q `°� ------------------------------------ Contractor's Name----------------�-W_N_�4� -------------------------------------------- Phone-------------------- : Installation will serve: Residence Apartment House E] Commercial F1Trailer Court E] Motel ElOther F]Number of living units: '❑ Number of bedrooms [F Number of baths ❑ Lot size--------;(ctV------- x----1-9-0_________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobaUl Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / QV (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticTqnk, Distance from nearest well_________________Distance from foundation------.-------------Material_____________________________________-_________- 0q��1 No. of compartments---------"----------------Capacity-----------------------Size-------------------•------------Liquid depth-------------------------- Cesspool: I Distance from nearest well-----------------Distance from foundation_-'-____________-_.Lining material__________---_---------------------- . ❑ Size: Diameter---------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______________________,______________-__ ❑ Distance to nearest lot line________________________________________- Seepage Pit: Distance to nearest well-----------------------Distance from foundation---------------------Distance to nearest lot line----.___________- ❑ Number of pits---------------------Liniingg material----------------------- Diameter-----------------------.Depfh--------------------------------- Disposal Field: Distance from nearest well---31 ____Distance from foundation!__249_!____-Distance to nearest lot line----j—__ y Number of lines---------1________x,7_______ Length of each line_________{,?__.___ --1------- of trench_________ I Type of filter material__t_rk"____l�t_ _Depth of filter material----I_�._______-___ 14 ,(_I Remodeling and/or repairing (describe)--------------1'" {�- -1.44- �-- -----_ E u /,�_Q L_ ------ ay—yc-----s_�.�1___ -_0----------- -- ----------------- -----------------------------------------------------"-------------------------------------------------------------------------------------------------------------------------•---------------- hereby certify +ha+ I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. (Signed) -- s ----- -----------------------------------------------------------------------------------------------(Owner and/or Contractor) By:---//--------------------------------------------------------------------------------------------------------------------------(Title)------------------------------------------------------------ (Plot plans, showing siie of lot, location of system in relation to wells, buildings, etc., must be filed with this application). 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- - - ------------------------"---- DATE--------- ' REVIEWED BY------------------------------ ------------------------------------------------------- i ---------- DATE---------------------------------- -F-1 BUILDINGPERMIT ISSUED---------------- ------------------------------------------- ------------------------------- DATE---------------------- ----------- Altera+ions and/or recommendations: /------•--- ----------------------------------•---------------------- ----------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- -------------------- ---- i ____________________ ____________________________________ __ ___4-____ _____________________ -____________-_________________- -_-_______________________-_ -_____________ ____ _ -- ---------------------------- PERMIT No." 1:577---- ISSUED-------- - --'Z---tO ----/--(Date FINAL INSPECTION BY:------------- ------------------ Date SAN JOAQUIN.LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639