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t APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) r",)plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ''rnis application is made in compliance with County Ordinance No. 549. 2Z3- d-fl� JOB ADDRESS AND LOCATION---------- Q-9-------- { r Owner's Name_--•---�-ktk-- '-P--i-------------- Phone__ . !P l$ ---------- Address----------P-nO---------- . a - 6 Contractor's Name------ ----------114-- "------------------------------------------------------ Phone___j_Z--3-W-------- Installation will serve: Residence;8 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms W Number of baths Z; Lot size--- _ __ ____ _y/_Q�-__________________________ Water Supply: Public system ❑ Community system ❑ Priva#� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,gyp , � Septic Tank: Distance from nearest well_4�_�-------Distance from foundation__.-_- ----___.Material------- _d No. of compartments----------2..r___,-----Capacity_____.?A0 Size-- - -- -- -�___.....Liquid depth------ Cesspool: 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----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter--------------------- Depth-----------------------.--------- �, sposal Field: Distance from nearest well--- Distance from foundation----X- -------Distance to nearest lot line---- _---_ Number oflines___--___�______________________Length of each kne__�a�#--------IV of french----___+?.,..��'_________________ Type of filter mate ria LX 0_C.--K----Depth of filter material-_--_ ____________ Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------- -------•---------------------------- ------------------------------------------------------------------•---•------------------------------------•--------------------------------------------------------•- --------------------------------------------------------------------------------------- ---------------------------------------------------------•--•----------------------------------------------------------------------- ------------------------------------------ - ----------------•----------------- hereby certify that 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, i -----------"'"`-r ----------------------[Owner and/or Contractor) (Signed) By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). O.,R DEP RTMENT USE ONLY APPLICATION ACCEPTED BY------- ---- - --= --------- ----- -� ---- ---------------------------------------- DATE----f -` - ---- ------------------------------ REVIEWEDBY-------------------------------------- ----- ------------------------------------------------ DATE---------------------�------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------0�------------------------------------------------------- DATE------------------------ ------------------------------- Alterationsand/or recommendations------------------------- ----------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- -------- •----------------- -- &*;:! ---------------- -�.:RM � �..___._ -- ISSUED__l� �_ .�--------------(Date) FINAL INSPECTION BY - zDate-------- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W4639