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# FOR OFFICE USE: ---------------- - - '------------------------ APPLICATIOtJ► ,FM,'' SANITATION PERMIT Permit No.6 ..l_ .d ----------------------------------------------'------ --- (Complefe in Duplicate) Date Issued --------------------------------- -------------- This Permit Expires 1 Year From Date Issued 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. !��- Ql -------------- JOB ADDRESS AND LOCATION---- - - -�C-_Rf -IL�I}- ------��--�t'"�-r�=- ---- -- ----- ��-�- --- --------- Owner's Name-- ` �� -------------------------------'----- - 23 ./Ls4-0 y -------------- - - - -------------'---- -'------ Phone----------------------� Address-----1.11C71-1 �/ a_/y` --Z9/F------- ---------=--------------------------------------------------------- --------------_----•--•--------------- Contractor's Name-------- :--Y--------_ Phone �--,� •------- Installation will serve: Residence ❑ part .n ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oflfe're ew-,td Number of living units: 13--.- Num of"bedro��--__._ Number of baths Lot size _ f / �� - 3--------------------------- Water Supply: Public system ❑ Community system ❑ Private �'�epth to Water Table `.2_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam eClay Loam ❑ Clay ❑ Adobe ❑ Hardpan 0 Previous Application Made: [If yes,date------.-------------I .No 291-�New Construction: Yes 2"'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: �-- --(NosepficYtank.or,,cesspooI permitted.if�public sewe ris available within,200-feet.) Septic Tank: Distance from nearest well-A90---Distance from foundation__ ___ �49--------.Material_/_4�__ .��_��..-.-. [y�� No. of compartments_____ _-__.-____-.__Size_ X-P-J64 --__3 quid depth___ �.�..._._____-.Capacity i"_4-___ Disposal Field: Distance from nearest ell.a,4•-,± _Distance from foundation__ZL---.__.__Distance to nearest lotGne_d�_._____ [G�^ Number of lines___.___ _.__-f._: _- -Length of each line_-_ �------Width of trench______r___________________ Type of filter material t7G -Depth of filter material_._ltF--------- otal length__0_.eV_,.:- ------------ -------- Q Seepage Pit: Distance to nearest well____________ ________Distance from foundation--------------------Distance to nearest lot line----------------- EJ Number of pits--------."-----------Lining material-----------------------Size: Diameter.----------------------Depth--------_---------------- ------ 5 Cesspool• Distance from nearest well------------------ from foundation-------------------- Lining material------------------- -------------.-_-- ❑ Size: Diameter ------Depth----------------------------- -- - -- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest ------------------------------------Distance from nearest building________ _----___-___________._______--. ❑ Distance to nearest lot line - ------------------------------ ------------------------------------------------------------ ----------------------------------------- -------- -- Remodeling and/or repairing (describe):---`��`�lrC!____ ..�� --- -- -- ------------------------ 3., j =------------------------------------- -- -----------•---------------------------------------------------------------------- I 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 ruleA and regulations of the San Joaquin Local Health District. )(Si ( r Contractor) gned)•-------------------- - -_ - _. = -=---- - -------- (Plot ---- =(Plot plan, showing size of lot, location of Sys+ in relation to wells, buildings, etc., can be placed 'on reverse side). 't FOR REPARTMENT USE ONLY APPLICATION ACCEPTED BY----- : L------ ---------------------------------------- DATE--------�-•-/0 ~(--7------ ----------------- REVIEWED BY------------=------'--- - //3/u 5- -------3 ---- 6 -----------------------._ DATE 1= 7 BUILDINGPERMIT ISSUED -- ----------------------------------------------------------------------------------------------- DATE----- ------------------------------------------------------ Alterations and/or recommendations _ --------- _______-_________ ___ __ -------------------------------- -- --------- --- -- -- - ----- ..n_'-'-' =� = � - - -- ------- •--•-•----------------------- --------------'•------ .... '- ---- - -- - -- -------' ---- ------_--------------------------- - ___---::-::_______--_______---- i ----------------------------------------------'---------------- ------------------- ------- ------ --- - ----------------------------- --- -------------------------------------------------'------- FINAL INSPECTION --- Date---- o�-- J -----T '-'----- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F -�