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FOR OFFICE USE: .� ------------ Permit No. '4�_ APPLICATION FOR SANITATION PERMIT (Complete 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 o. 549. 5 6 t ........................... JOB ADDRESS AND LOCAT ON._6110 ------------------------------------------------ (?t---- -�------•- -- `+ ... t � --••--- . ... , �» -----•Phone------------------------------------ _______________________•_--_______________._._- -__.__._....__. _-..... -•- owner's Name--------- , i_. ____-___ _....._._ r p '. .a- �- -- •._.-_------------------=---- = .............. --------------------- Address Contractor's Nam ------------------- `1-------------------=---- ... Phone Installation will serve: `Residence,Apartment House ❑ Commercial ❑ Trailer -Court ❑ Motel ❑ Other ❑ V / �.t J ..................... f Number of living units: _..,l.-Numb{r of bedrooms .1__- Number of baths ._1-_ Lot size __ - •+P Water Supply: Public.system Community system ❑ Private ❑ Depth to Water Table^doft. Character of soil io'a depth of feet:^Sand ❑ Gravel ❑ Sandy Loam ❑�Cley Loam�❑4-rClay ❑ Adobe�ardpan ❑ '• I �l I: �: �`El,--N6' FHA/VA: Yes ❑ No�� Previous Application Made: (if yes,date__________----------) No [� New Cons TYPE Yes ®� i TYPE OF INSTALLATION AND"SPECIFICATIONS: ~- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Xankt Distance fromr :.nearest weh-----------------Distance from foundation____�___��.___. __.Material:.,_�___,..____..._._.•........._.-.......... )q No. 01 'com a�trnents ---Size•---------------•----------- .Liquid depth------- - Capacity---•.................. f DisposaL Fields Distance from nearest well-----------------Distance from foundation------------- -----Distance to nearest lot ine------------ y�,��r Number of. lines`_.-------•-------------------- Length of each fine-------•----------••---!_._'..Width of trench'------.------•----------------••-- z5x�/ +"?' - .i Total length"---•------------- ---------•------- Type of filter material-------------------------Depth of filter material________.-----_--- l 0---__.__.Distel ce to nearestlot line-.��_---_-_ Seepage Pit: Distance to nearest well_--__�--_-.Distance from foundation__ o Number of pits..--- ------•------Lining material__ ----Size: Diameter- - ---------- -Depth_ s>�--•----...------••- Cesspool: Distance from nearest well-----------______Distance from foundation._-____.____.______.Lin-ing material_r`____._'_.__:__.____...____._..._.. Li uid Ca aci -----gals. l ❑ Size: Diameter----{-------- -----------Depth--- q P tY _;,---- --- --------- ,. , .._�..�_ ---------------------- - Privy: fbisfance from nearest well________________________________________ _______Distance from nearest bull' ing_____.__._ ' '� _--- = ' ❑ �Distance to nearest lot line; _---- ----------- ----------------- ling -- ,_- ,-� = Remodeling and/or repairing (describe):.. -------------------------------•---------- ----------------------- -=------------------•-------------------------- i. : -. •-------- - --------- -----•- = 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 rules and- regulations of the San Joaquin Local Health District.. ® ,,y�' Cantractorl ' Si•ned " .�h�'�' } --------rale - --------------- r [Plot plan, showing size of lot, location of system in rel to wells, bui dings, etc., can be placed on reverse side). 7 i i� f l .. M a DEPARTMENT USE ONLY �. APPLICATION ACCEPTED BY_1ai ____ +i.��e. /--- - ------- DATE_'__ Z REVIEWEDBY---------------------- ---------- ----------------------------------------------------------- DATE BUILDING PERMIT ISSUED________________________ ' �, ----- I AFferations and/or recommendations:--____. " ---------------- - ....--------•-•---------------- i ------------------------------------- - ------ ------------ ----------- -------------------- -------------------------- , ,,, Date... - l i. ? 71 -------------------------- FINAL INSPECTION BY:_ /Y--- SAN JOAQUIN LOCAL.HEALTH DISTRICT 130 South American Strut 300 West Oak Street N° 124.sytam6re Strait 205 West 9th Street Stockton,California Lodi,California fdanleca,California Tracy,California ES 9 REVISED 8-99 2M 5-61 ATLAS