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APPLICATION FOR SANITATION PERMIT Cp 6 (Complete in Duplicate) 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 LOCATION---------------544__,S_ aarde-11-------------------- Owner's Name----------------EnY_in--G_.___Kun�iert-----------------------•----------------- ------------ Phone 4--'�'o91-4-----------= - _ t �. -------------------=------------- Q �� ' ----------------------------- --------------------- Address Name-----------------D_eltr'�,-------------------------------------------------------------'-------------------------------------------- Phone �55------------ Contractor's . Instal{anon will serve: Residence ® Apartment House ❑ Commercial ❑ 'Trailer Court 0 Motel ❑-1. Other ❑ x Number' of living units: j] Number of bedrooms a Number of baths [2 Lot size------------- -- Water Supply: Public system ® Community system ❑ Private ❑ 'Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay El Adobe [ Hardpan F1 U ' --TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t well----------------- from foundation__________________.Material_____________________________________-____--_. .Septic Tank: Distance from neares EXTSMING No. of compartments--------------------------Capacity Size - Liquid depth !, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------------- r ❑ -------------- Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-----_-------------------------------------------Distance from nearest building-------------------------- ❑ ., Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well_____-r____________Distance from foundation___ .Q_-______.-Distance to nearest lot line_______ZQ__: s Number of pits-----I--------------Lining material-------br_iQk__Size: Diameter-------��-----------Depth---------25.................. 1 Y i D.is osal Field: Distance from nearest well-------__----_ Distance from foundation------_-__________Distance to nearest lot line_____ ---------- S _---____. i Tl Number of lines------"-"------------------_------Length of each line----------------------------.Width of trench_ .---------------- so]:i® Line - I ' to tank Type of filter material_So.1id___-- -Depth of filter material------- ______________ Remodeling and/or repairing(describe---------------------ins.t_9.11ing--nevi---T ver—t x-a-1--drabn---oiLly---anc ------------------------ ! t eX-1-acing a-apt-j-Q---tank__�r_1-th__so_lid---11ne---------------------------------------- ----------------------------------------------------------------------------------------------------------------------- --- _ hereby lavish and regulations ----------- ----------•-----------------------------_--------------------- ------------------------------------------------------- I ----------------------------- ------ ^ll .i prepared this application and that the work will be done in accordance with San Joaquin County ordinances, g ns of the San Joaquin Local Health District. , ---�e1 � ----------- ----------- --___-______Owner and/or Contractor) C (Signed) - - --- -------------------- ----- • By:--------------------------------------Terr_----Y�i _tl an � [Title] - - Q��rn r--Iii'A (Plot plans, showing size of lot, location of system in relat n to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY .. J APPLICATION ACCEPTED BY-------------- �,,� (�+` -----------.DATE----�� r� -�f��-__1-------------------= REVIEWED BY----------------------------------------------------------------------------------- DATE - BUILDING,PERMIT ISSUED________________"""---------------- ------------------------------ DATE------------------------------------=--------=--=------------ Alterations and/or recommendations--------------------------- ------------------------------------ ------------- ------- ----------------------------------------------------------- _____________�______________----___._ ___________________________________________________________________________________-_______,_________________--__-_ __________________________ - _ _____________________________________________________________ . }� 'ISSUED- c3------------(Date) FINAL INSPECTION BY: -------------- h ---- . PERMIT No,----------------- ' tt Date----------------- �--- -§,k-------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street ti Stockton, California ES-9-2M 9-50 W-1639 '