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PERMIT 6 j APPLICATION FOR SANITATION PE (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, 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 2607 SQ•-- $ieghtle---Street_,---StQckton------------------------------------------------------- is H Owner's Name---------------------------------------------The- ry--Z-F---W1tki=----------------- -------------------- Phone---------K-One---------•----- Address---------------------------------------------------------2--6Q7---SQ-----BleZb .e_-_Street----------------------------------------------------- :------- Contractor's Name------------------------------------- •---A•-- ----------------------------- Phone----------9-9b07-------- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of iivin units: Number of bedrooms Number of baths [I Lot size______6 __ � - 5 _x86------------------------------ 9 Q. 3 Water Supply: Publics stem Community system Private I PP Y� Y � Y Y ❑ ❑ 0 � Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe [X Hardpan ❑ 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------NOneDisfance from foundation 20 f _Mateyiai_._C_SS -CimB Ilk 00 GS ___ -- XbLid ----------No. of compartments 2 ----Ca Capacity ------__ eX3----------- - _- Iu _deth------ Cesspool: Distance from nearest well-----------------Distance from foundation_---._____________.Lining material------------------------ ---------- El - 52 _-_-__ ❑ Size: Diameter Depth------ -------- -------------------------------------- Privy: t Distance from nearest well_______________________________________________Distance from nearest building------------------------------------------ ❑ Distance to nearest ]of line----------------------------- Seepage Pit: e Distance to nearest well----------------- _Distance from foundation-------------------Distance to nearest lot line_____________ ❑ Number of pits----------------------Lining material-------------------------Size' Di.ameter------------------------Depth--------------------------------- _Disposal Field: Distance from nearest well------NIIY1QDisfa'nce from foundation____29Z--------Distance to nearest lot line__-t---------- Number of lines_________________________________Length of each line--------']_5---------------Width of french-----------24rt Type of filter material--------1V___11kDepth of filter material---------18t'_____ Remodeling and/or repairing (describe):----------New---installatian ._•__-Flay-d__'T"ract------------------------_-------------------------------------------------------------- ----------------------------------------------------------= --------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 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. J (Signed)-------- P K-- +S thIO.-------------------•------------------+------------------------•-----------{0860[laW Contractor) $ � _---- -- ---- --------------------------------------------------------------------(Title)----EST-IMATCE--------------------------------- (Plot p s, a of lot, location of s em in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ------------------------------------ -------- DATE-------- - REVIEWEQBY -------------------------------------------- ------------------------------------- --------------------- - • DATE----=--------------- BUILDINGPERMIT ISSUED------------- ------------------------------------------------------------------------------------- DATE--`----------------- --------------------------------------- Alterationsand/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- ------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- 1--------- ----------------- ------------------ --------------- ------------------------------------------/ - --------- ---- PERMIT No.___6_ -._ ------- ISSUED__-- 'y._ /_______(Date) FINAL INSPECTION BY:___ -------------------------------------- Date r��%' . /Aw-------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street Stockton, California - �5-9-2M 4•SO W=1639