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Permit No. �J( i r �IpN FOR SANITATION PERMIT pPLICA yJ (Complete in Duplicate} Date Issued ___--_/�1:SS" ;: in Local'Health D rico`for a permit to constru ct and install the work herein described. Applica}ion is hereby made to the SanDoaq� Uounty Ordin o. 549. 1 1 �FSQ-ab This application is made�m compliance vith. u - _: Phone__. JOB ADDRESS ND LOCATION--- . -"- - , t, --- ----------- - -- --- K," ., - --- ----- �.. _ : Owners Name----- --- - -:•----------•----- ---------------------------------------------------------------------- 40 Address-_-------------•-•-- - ------- --•-- one.__. A , e ---------- . --- . Contractor;s�Nama_____________0___ _ . ]artmeCommercial ❑ Trailer Court ❑ Motel Other ❑ ---------- Installation ,� Residence P will serve: ` " '- • ` umber of bedrooms j-- Number-[of baths Lot:size _._______ Number.ofylivin9 units: _._- _1, � Communit s stem ❑. Private Depth to;Wafter Table ____-___ ft. a Water Supply: Public sten`j y Y Clay Loam ❑ Clay ❑ Adobe®- Hardpan ❑ t. Character of soil to,a.depth of 3+eat: Sand ❑ 'Gravel ❑ Sandy Loam ❑ Y i /, No i New'Construction: Yes 4 Previous Application.Made: Ye ❑ s TYPE OF INSTALLAr[ON AtA SPECIFICATIONS: k "�" ool permitted if public sewer is available-within 200 feet.) a (No septic tan' or cc P P ^ -r " ` Mat ia4 -- Septic Tank: DIfan:e-from nearest well__ ---Distanc�,f,�O anon. Ca acit ------------- f p Y--- Liquid depth �------ -------------- ( �{ Capacity--- N compartments__.__. Size �;'" • � _.Distance from foundation___-__ _�"-�-----Distance to nearest lot line_f-�-------••-- � Disposal Field: bitance from nearest --I' __:: Len th of each line i0` 0-6m�dth of trench._ __� , Ntnber of lines g Total length _ Depth of filter material___��`---------- - Ty;e os filter maferial__ I' r Seepage Pit: Di nce to nearest well.______.__:"-I--------Dteaal e from foundxen-piameter "Distance toDepthst lot _: _.- ❑ -------- <U,4 be of pits_._ `- Lin g Cesspool: Disance from nearest well_____'_-_-___--Distance from foundation_______---- -Lslnuid Capmatacity gals. Depth--------------------- ---- q . #� ❑ Size Diameter---- -:-` ---------------rf I '-_Distance from nearest building__ Priv Distance from nearest well___.__' -----""---- -- ------------- ❑ -----------------•----: •- Dist��ce to nearest lot line=_'__"'_:_'------------=- - _ ,. { a t .. T Remodelisig and/or repairing' (describe):_. -' ----- r.--------:------ = - ,------•-----•-----•- -----------------• -"--•-----------_---- F "'"""" ------------------- -----------------• - -------- - ---------- # � , . , a t �. . ------------- --------- 1 ------------ - ----- ------- -------- _ I hereby certify t}iat'I have prepared'this application and that the work will be done in accordance with San Joaquin County R 'San Joaquin Local Health District. ordinances, State laws, and rules an 'regulations. f tire+ (Owner and/or Contractor} • ------- -------------- w �- S� ned ---------=�-�-----•--•------=-------•---- ------ ------------ ellsbuildings, s, ..._{T1+1 ). (Plot plan, showing.size of lot, location of system in relation to webs, buildings, etc., can be placed on reverse side ,J FOR DEPARTMENT USE ONLY-- APPLICATION ACCEPTED EPTED BY_____ ________ ___ "-. --.- -- - DATE-----------�} - ------- ------ ---- -------- ----------------- �------/--�-�-`-�--�---•---------•-- REVIEWED BY---- ---- -------------------------- ----- --- DATE--------------------- - . BUILDING PERMIT ISSUED____________________________ ------- - ---------------------------------------------------------------------- Alterations and/or. recornmendations:---------------- ------- : '---- -------- ------------------•---•--------------- -------- ----------------•-----•----•-----•-----••--•------•-----------------_-------------- W f ---- ---------------------------•---------------------------------------:--------"--------=`------------------- I --------------------- , INSPECTION BY:. - Date._-- r ' � . __ ' �f __ _ FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT " 132 Sycamore Street 814 North "C" Street E30 South American Street 300 West Oak Street Y Trac California Stockton, California Lodi,California Mentees, California Y' ES--4-2M Revised W-2100 --- -