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- APPLICATION FOR SANITATION PERMIT Permit No. 1��36 (Complete in Duplicate) Date Issued Application is hereby�ma e 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 AN Q LOCATIONh�-4- -Z? -----------WA-rf-%5---------*1-I/e.*------------------------------------------------------------------------- Owner.s Name----------K-9-1......0-1-1\14EARA------------------------------------------------------------------------ Phone-,,Fns—ae-------... ------- ----------e ---- - ------------------------------------------------------------------------------------------------------------------- Address------------------- ---------------- Contractor's Name-_----.. :k,-59 z4VV,5-------/ --------------------------- Phone--- - --7-------- Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ] Motel E] Other 0 Number of living units:41PY4,Number of bedrooms -I--Number of baths j---- Lot size ---X-1-1215 ________________________ Water Supply: Public system � Community system E] Private Fj Depth to Water Tabled"57ft. Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam [-] Clay Loam 0 Clay [I Adobe x Hardpan E] Previous Application Made: Yes E] No New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundafio-n-------------------Material------------------------------------------------- El No. of compartments--------------------------Size--------------------------------Liqu;d depth--------------------------Capacity----------------------- Disposa; Field: Distance from nearest well------------- -Distance from foundation--------------------Distance to nearest lot line_________________ ❑ ine----------------- El Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material------------------------Depth of filter material-----------------------Total length_________________________------__-____-___ Seepage ength------------------------------------------ Seepage Pit: Distance to nearest welf_ft./VS-----Disfanceirom foundation---1457--f- Distapce to nearest lot line___________ 4T*-" Number of pits-4_eT�- -----Lining material-b-6-1C.ff—Size: Diameter_ 9.3 Depth---a- Cesspool: Distance from nearest welJ-----------------Distance from foundation--------------------Lining material____________________________________ ❑ aterial---------------------- F-1 Size; Diameter--------------------------------------Depfh----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-- ----------------------------------------------Distance from nearest building----------------------------------------- F-1 Distance to nearest lot line --------------------------- - ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-- --------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------X-------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ------------------------------------------------------------11---------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have"epareedd thii�s application and that the work will be done in accordance with San Joaquin County 0 ordinances, St + laws, and rules" d reguTlanfio.s of the San Joaquin Local Health District. --- ---- ---- -- - ------- -- --- ---- (Owner and/or Contractor) (Signed)--------- ----I-- ------ 4----- -- ---- ....... By:--- --- ------ ---AA - ------------------------------------------(T ---------------------- (Plot plan, showing size of lot, location of sysf m in relation to wells, buildings, etc., can be PIZ on reverse* side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ---W-- --------------------------------------- DATE---- REVIEWEDBY------------------------------------------------------ --------------------------------------- DATE---------------/----------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------—---------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------- ---------------------- ---------- -------------------------------------- FINAL INSPECTION BY:---------- --------------------- Date------,.X �--- --------------------------- 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 8-51 Revised W-2100