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Permit No. ION FOR SANITATION PERMIT APPLICAT / (Complete in Duplicate) Date Issued ----- ---------------- n Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San County Ordinan No. 549 This application is made in compliance with Cc C ------------------------------------------------------I-------------- L .CATIO ------------- ------ ----- -- ----- ----- - - ---- ----- -------- ---- Phone_c�_�n_s'il-k-21---- JOB ADDRESS -- ---- - - - -------------------- Owner's Name..... ---------- Address---- --- ----- -------- - -- ---------------------------------------------------------------------------------------------- -------- Phone----------------------------------- --------- ---- ----- ------- - -- ------ - ------------ Contractor's Name._ enc-e A-p I a.rtment-_House-_El---- Commercial C] Trailer Court 0 Motel ❑0 installation will serve: Residence rooms Number of baths ---I---- Lot' size ---- --------- ------------------------- Number of living ng units: - 11 - Number of bed Water Supply: Public system [Community system [] Private ❑E] Depth to Water Table -------- it-Sandy Loam M/Hardpan C] feet: [] El am / Clay Loam [I Clay Ej Adobe Char cter of soil to a depth of 3 f Sand V New Constructic ;�N o El Previ:us Application Made- Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Materla4------------------------------------_---------- -----------------Distance from foundation------------------- Capacity-..-.._-_---- t. Tank: Distance from nearest well -_-Size-- ------------Liquid dept ------------ ------------- No. of compartments.__.-_.__-- -------- istance, to nearest lot lin --------- istance from foundatio ------------ ---- ----- I "Width of french-------(--- ---t------ nearest I'll 05 Distance from p e of each line-____-- " tr .9-0------------------------ o.r lines----------4-5 -Length -----Total length-----------/ (A Number I 0�! I - __ epth of filter mater Type of filter ---Z_ _. 4AI nearest well :_---.._.Distant from foundation-------------------.Distance to nearest lot hne__ Distance to ne -------------- ---------- -----------Depth..--------------- Seepage Pit: Number of pits..-.._____"-----------Lining material---------- ------------Size: Diameter_.Lining material------------------------------------- nrn nearest well....__-.---------Distance from foundation_. oundation---------------- --Liquid Capacity--- ----------------.-------gals. Cesspool: Distance from -------------Depth----------------------------- ----------------- -- n Slzt�: Diameter------------------ ------ ------------------"----Distance ---------------------Distance,from nearest building---_--------------- ---------------------------------- Privy: Distance from nearest well--------------- ----- ---- ---------------I------- ---------------------------- - ------------------------------------- n Distance to nearest lot line------------------------------------------------ - -------------- --------------------------------- ----- Remodel d/Url�P P q 14 WIg -- - -------------------- ---------------------- 3 --- ----- ---- -- - --- --------------------------------- ---------------- ----------------------------- &---- ------ ---------------------- ----------- ---------------------- -----------------------------------I------ ----------------- --------- -------------------------------------------------- ----- - ---------- --------------------------------------------- ---------------------------"-----•--------•-------------------- ---------___---------------------------------------------co in accordance- - with San Joaquin County ------- --- ------------------ - -_ � ------------------------I-her e by certj-fy_.that I have-_prepared, - - -this--- application and that the work will be done ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.I (Owner and/or Contractor] (Signed).--------) ...... ---------------------------------------------tTffle)------------------------------------------- --------------------- --------- - - --- ----------- --- --- - ------ -- By:---...............................sire o f lot,-loca+1-o-n of--system in--relation-- -to wells, buildings. etc., can be placed on reverse side). (plot plan, showing R DEPARTMENT USE ONLY ------- ---------------------------------------DATE.-::;,----------------------------- ------- ------ ----------------- APPLICATIONACCEPTED B ---- ------------------------ ----------- ----------------- ----------------- ----- DATE-_,_S�6-------------•------------------------------ ------ REVIEWED BY------------------------------ ------ -------------------------------------------------------------------------- --------------- BUILDING PERMIT ISSUED--------------------------- --•------------------------------------- --------------- Alterations and/or recommendations:--------------------------------- ---------------_-------------•-------•---------- Al -------- 1.� ------------ ------------ ------------lev e;4k ---- ----------------- ------- ------ ------ ---------------------------------- ------------------------------------- ------------------------------ ------- ----------- ......�AA_j---0 ------------------- -------------------------------------- -- ------ —----- ------ -------------- - _J - ---- -- ---- V' -- - ------------ A P Date--------------- ----------- -- ------------ ----- FINAL INSPECTION BY:.-.--__________________ JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 Norih "C" Street 130 South American Street 300 West Oak Street Tracy. California Lodi, California -w-mantaica, California Stockton, California rr,_9_2M IC-52 Revised W-2100