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r�rc c�rri�t uat: --- -------- -- ----- ---------- - --- L ____--.--- AP�CICATION FOR SANITATION PERh./ Permit No. c �..L -- - - - ---- - ........ -------------------------------------------------- (Complete in Duplicate) Date Issued -1 .-----___--.------ ---- ----- -------------- This Permit Expires 1 Year From Date Issued Ls Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. z�his aePlicatiof is Tate In ccoom$elianc with County Ordinance No. 549. RIPS "7(�B S. f2 JOB ADDRESS AND " ON ALK -- ----R-Q. - V ..el+` x -GRA-VLOC � ��` ` Phone F—QROwner's Name - CL Address.---------...... R-i-PQN/-----___------------------------------ - ' LContractor's Name..Ah( Q/1) - -Sa ------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑? Commercial E] Trailer Court ❑ Motel [I Other [Ii Number of living units: _I_.._ Number of bedrooms) �- - E- _._ Number of baths ._.____ Lot size ._. �� - �' ----------............ --- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand [q`Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan;lies ❑ Previous Application Made: (If yes,date_.------.,--------I No,�New Construction: Yes B-`o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 6. Se�ti�c Ta •� Distance from nearest well---S0-----Distance from foundation...Y-Q..-.._..Mate ial._.QaNCf faT-a- _ ___ ----- IIIe4Wc..I+�E No. of compartments..._-Za...__.._._.Size__VXZOA.�_Liquid depth.."�...r�,.____..Capacity...l .p.. V Disposal Field: Distance from nearest well.--_57_<7-----Distance from foundation---/.Q...__--Distance to nearest lot line.__.--?...... 151tD>TfA(G- Number of lines---------./.p--..._------__.___Length of each line..../l�-r7--.---j�----Width of trench._....-- -.,._.._�--_____ Type of filter material_/t-0C&:_Depth of filter material.._1e9..._.._Total length.-----------f.199---I_..__---- L Seepage Pit: Distance to nearest well_____ ___________.__.Distance from foundation____._...-..-__-_..Distance to nearest lot line_.__..._.__... _ ❑ Number of pits.._.___..__---___Lining material--------_------------Size: Diameter------.----------------Depth-------------------_..._._... � cesspool: Distance from nearest well._____.___._._Distance from foundation--------------------Lining material.------------ _._. a Size: Diameter- -----------.._Depth------------------------------------------'---Liquid Capacity-------------------------gals. U Distance from nearest well__.._....._.._.__.__.._._.._-_.__._._._-.Distance from nearest building.._._ -_. ❑ Distance to nearest lot line_ ----------------------------------------------- `--------'------------------' Remodeling and/or repairing describe __._-7AN ___ ._�I2Q..... _._..._. ----------- - Ct_ 1.-N-�=-- D&Ai_Atn .-D,jE� ------------------------------ ---------------------- --------------------- -------- T;w_o-:------ ------------------------------------------ --.------ _ . -----------------------------------.-------------------------------------------------------------..--------------------- --------------------------- --- .------- ---------------------------- I hereby certify that 1 have prepared this epplirption and that the work will be done in accordance with San Joaquin County ui}7 Local Health District. L (Signed)dces. 5 laws, and rules and regulations `rof6ihe Saq'Joaq (�= --------------- -- -------- ------------------------(Owner and/or Contractor) ---- `/1 y. ------ 1 r+le FOR Dion to wells, -g . . ( )- - - L (Plot P B g y s, buildings, etc., can be placed on reverse side). Ian, "wing size of to#, foe�tio s s m relation to wall NT USE ONLY // L APPLICATION ACCEPTED BY---------�f�,o' --------------- -------------------- ------------------ DATE---------.;Z..__�D_..'ZZ--'-------------- REVI�WED BY - - - ------------------- :--------i-------- - _. DATE - - - - - - BUILDINGPERMIT ISSUED------- _ ` ' _ -------- - ------------------------------ - DA" ------------------------------------------- L Altera#ions and/or recommendations:----- ub-M...._.... ------L.f-....../:/9�YA. r .:------- -..-------------------------'----------- ------------------------------------------------- .................................. V -------- - -- - - --- --- --------- - - - -- -- - - --- - --- ---- - - - FINAL INSPECTION BY- . . _ --- Date------- .--'./. :_� .-- ------------------------- LSAN JOAQUIN LOC,1L HEALTH DISTRICT P ATE 11, Page 1 of 16 3601 E.Haeeiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street LStockton,California Lodi,California Manteca,California Tracy,California r.P.CO.