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Permit a� APPLICATION FOR SANITATION PERMIT N°• Y (Complete in Duplicate) I / Data issued __-�r '�f 5 ---------------- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549/) , JOB ADDRESS AND LOCATION"...Le/_0---- Ql 41- --------- = /)? ? 404," Phone -- Owner's Name.-- - -�- --•---- ��_Ql L-----------------------------------�---------------------------- --- --- -- // ' �� / b _ ---- i Address Ce -- Phone ---Q---`---�----• - - Contractor's Name__." C� �!/� . .-oho---------- ----Q� -�-------------------•----- -- - I r Installation will serve: Residence Apartment I louse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ off. Number baths --/---- Lot size ----- --'�X -va------------------•-•-------- Number of living units: _"e_-"- Number of bedrooms __ " " �- _---- Publics stem ❑ Community system ❑ Private Number to Water Table- ft. Water Supply: y Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam El Cl Loam [jClay ❑ Adobe Hardpan ❑ ' Previous Application Made: Yes ❑ No 5New Construction: Yes -] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub�csewer is available within 200 feet.) Septic Tank: Distance from nearest well-",_ �"-.---Distance from foundation"_I�""-_"-"""__Mate a/----�-C---�------� i. Size / Liquid de th---- /---el- -------- Capacity_.. d" - No. of compartments------------a L------ +a t!�-��----- - q P. -� Disposal Field: Distance from nearest well._..__"._Distance from foundation Distance to nearest lot line_ "--"-__.__" Number of lines-----------•--I---- -- -----------Length of each line-- ---- j -- -------Width of trench-,,., ------------------ ----� -------------------------- Type of filter matenaI------ ................. "ROU", Depth of filter material_""! "."".---..---Total length fSeeps a Pit: Distance to nearest well--" "�.-"------Distance from foundation_.-�"_-.--..D?t,,arce to nearest lot line,-S-------- Number of pits--------- ------------Lining material-�� {r✓4._-Size: Diameter----------------- ----Depth-."--"-� -------------------- Cesspool: -------- ----- Cesspool: Distance from nearest well------------- Distance from foundation------------------- Lining material-------------------------------------- Size: Diameter-------------------- ----------- ❑ - -Depth ------------ ------------------------------------Liquid Capacity- ---------------------__gals.. - - Privy- Distance from nearest well--------------------------- ----_-----------------Distance from nearest building----------------------------_----------- ❑ --- ---------------------------- Distance to nearest lot line_-.".._.-." "---- • ----------------_•_:-_----"-""-_--"" ------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------------•------•------••----"-••-------••-----------•-•-------------•-------------- I hereby ce ' y at I have repared this a lication and at the work will be done in accordance with San Joaquin County ordinances, Sta I s, and rut nd regulatio of the San quin Local Health District. _____ (Signed) Owner and/or.Contractor) = -�--` -- ------- �'"� f_.- �`r'`------ BY:------------- --------------(Tit e} ------------ --------- ------------------ By: ----------------- (Plot plan, sho. i g size of lot, location .. system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT U_SE ONLY : APPLICATION•ACCEPTED'BY--------------------- -- - ----------------- DATE----------- --- � � ----------------------- ----------------- - - REVIEWED BY----- ---------------------------------- --------- -------------- ------- ---- -------- ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------- •----------•------ ------------------------------------------------ rDATE Alterations and/or recommendations---- ---------- ------------- ---- ---• ---•--"------------------------------------------ ------------ -------------- ---"-"------••---------------------- ----------------- --- - --- c -_kms --- err€ '. 17 ,-. lr y ------------------------------ ----------------------------- --------------------------------•----------------``` - t- Date--- ` ------•- FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street E30 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y, E5--9-2M 145446 ATWOOV 12.54 _ _