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/z Oy�QFFICE USE:FSR :/_2�v----- --. _,-_ .____..___." -------------- APPLICATION R SANITATION PERMiT -Permit No. 6z ti i _6 (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ..fa�/�5/ k 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. /'p JOB ADDRESS AND LOCATION----------------------Me/---- C�£ c ----------------------------- Owner's ---------------------------Owner's Name-"- / - ----�--�-----------------®�r -------------------- ----- ------------------------ Phone--------------------------------- ------ -- : - f o ----------- -Address.Contractor's Name ------------------------------------------------------------------------------- -----------••---•------------------ Installation will serve: Residence Apartment House ❑ Commercial.❑ Trailer Court ❑ Motel 0 Other ❑ � s Number of living units: __ __ Number of bedrooms -/4/- Number of baths _,;-_- Lot size _ ,X.- - "__-"----------------_"-- ) Water Supply: Public system [p<Communify system ❑ Private ❑ Depth to Water Table 4�4�7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe[-Hardpan ❑ Previous Application Made: (If yes date_:..- No [C}/ New Construction: Yes R?`no ❑ FHA/VA: Yes ❑ No R4— TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) _ Septic Tank:] Distance from nearest well----_________----Distance from foundation-AWA......_ Material A/ _ 1' No, of compartments---/------------------Size._0.x------------------,•••Liquid depth_--- --------------Capacity -p- '�© jr I Disp�sa Distance from nearest well._____- ------Distance from foundation_ __e"P__ __-_.Distance to nearest lot line-_- Number of lines------Z----------"_--- -----" Length of each ------ _ - Width of trench---._�--j------------------------ l; Type of filter material-_�_j �.'' Depth of filter materral_._4 _ ------Total length__.._��--_ Seepage Pit: 9. Distance to nearest well------- �-------Distance from fo nda+ion---!_Ct!_....___.Dista�a to nearest lot line-47- ...... Z�� Number of pits_ _7_/A923N ming material__" �Ei ""-Size: Diameter---19-----------Depth_,z _ ✓{:-- �, F Cesspool: *Distance from nearest well-----------------Distance from foundation--------------._,_..Lining material------._._--_---.-..--."----_-____.__: ❑ 1.'Size: Diameter----------------- --------------------Depth_------- ------.Liquid Capacity--- --------------------- gals. Privy: /Distance from nearest well---------------------------------._--------------Distance from nearest building__--_..___.---__..______---_.-.-,_----"-. ❑ Distance to nearest to+'fine. `------------------------------ ----------------------------------- -------------------- Remodelingand or re irin describe :._._ ,, ✓ / P ( 7 -------- - - lT .. %��E� f t _ - -_ -' -----x`----- --------------------------------------------------------------------- t -- - - �'2 ------------�------.--- ---- ----- - f-' -- -�---rte -- - -�-- ------------ ! hereby certify fhafA have prepared this:application and-fhat•.the work will be done in accordance wifh San Joaquin County ordinances, State"laws, and rules-and regulations of the San J'W' uin Local Health District.., v � � 11 (Signed)---- -- = _ !L`�r - -------- ----------- r X-------- ----------------------------- --- r Contractor) By --•` --------------- ------=- 6`A------- �f C Lv / (Plot plan, showing size of lot, locafion of system i lation to wells, buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY. . 'APPLICATIONS ACCEPTED BY----- --- -------------------------- ------ ------------------------------ t--- --- DATE----- - REVIEWEDBY------------------------------------------------------------------------------ - ---- - DATE BUILDING PERMIT ISSUED ------------ : DATES = ----- ----------------------' Alterati ns aAdIV recommen {'ons:._---..--."_____ __________________ ------------ ----- --- - ------------------------------------------------- { FINAL INSPECTION BY:.........LC-. ------------------------------------------- Date_---- -----------f - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. t k 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F F.P.c o. `t _