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APPLICATION FOR SANITATION PERMIT Permit N (Complete in Duplicate) Date Issued --- ,IVA 02-0- 2-1 Applica+ion is hereby made to the Son Joaquin Local Health District for a permit to con truct an in the work herein described. This application is made in compliance with County Ordinance No. 549. P�ona' Con ,m�ors Name ------ Installation . ___________ , �� v� ��: " ��n� r�ent H�� Commercial � T�|o, C�+ � Wn� � C�o, � '- r~-- ' � ' - ' ' � �� Number of |i�ngunits: /- Number ofbedrooms ��.. Number of6*+� .2_- Lot �zu -_�"�/0,0_ — Water Supply: Public system E] Community system te El Depth to Water Table /40- ft. Character of soil to depth of 3 feet:' Sand [� �� So�y L�m �] Ooy L�m �] ��y [] /�� Hardpan Previous Application Ma6o: Yes [I No Cg_ 'New Construction- Yo` Eg No [] .� TYPE (�F \NST/4LLAT\��N /�NO SPECIFICATIONS: - 3~% (No septic tank or cesspool perm1ffad if public sewer i, mvoi�6|o wlf6ln 200 feet.) , � Septic Tank'` Distance from nearest .eU ,�� '-Distance from foundation .^�&� �Mo+e,iu-\ ��& --c-�-^�C�a Capacity___.,. ...... _ RL No. ofcompo�mon�----- J ---- Size..%6--Td -Y_.&Z.-Liquid �vpfk-Disposal Field: D�o+ancc from mo*ra,t well Distance from foundation ' r'--Didnnco to nearest lot |ino_��-�. _�� *m�� ^ O�- Number of lines `� yr-'LungH, of each line H` ofhnnck-'.��..-.�� --_ ~� Type of��+er moter|oL 4of filter �. vr mnloruI.......... n+o � '' �_-___' mo�6 ^ Sa"�p"y� pit' Distance~to nearest well Distance from foundation . Distance to nearest lot line----------------- J ` - Num6ar'ofpits'-''-------------Lining material '-�'_''-Size: Diameter Depth- C*0000l' Distance-from nearest well- �Distanm, from foundation . Uning material . .�_-__ �^ I;ze: Diameter.--''�-''_--'-Depth - ' Liquid Cummc� _gum� . Privy: Didu*c= trom nearest well- . D;stunce from nearest building------------------------------------------- n . . . ---_''- , [ D�tunc� to nu� ,,� |o+ |i"" ____._,____ ___ Romo6oing and/or repairing kclescri6e :-.- -------- ------- --------- -------------'----------------------------------------------------------------------------------------------------- --'_----__-'-___._----'_------_----------._----.--_---_-_._-_--.-_.-' - ---------.---�__.__.''--_'-_-''--''_-.-_.---'__'---'_-_--__------------------------------------------------------------'-'-''--'-'-_ ___---.'-'--_--_--_-----'_--__-----.--.--'_-------''--.-__----.. I hereby certify that I'----'------'--'have this and that the work will be done in accordance with Son Joaquin County ordinances,4Sfate s, and. rules and regulations of the San Joaquin Local Health District. AL �P|mf plan. o��w�n� o�e �m |o�. ��mnmn mr �y�mm m ,�/p"°" .° ~=".. ~..~..�° ~.~. can be placed on 7- FOR DEPARTMENT U-SE ONLY - - - ------------------------------ .-- ------------- --------------- ------------ --------------- ---- -------------------------- ------------------------------------ ------------------ ------------------------------------------------------------ --'---_''-''''--''-'''_'----'''_'-''''-'--'''-'''-''---'''-''---'-'''-_-'-_-'-'-'--'_--'-'_ --''-'''''-'--'--'-'''' .... -------------------------------------------------------------------------------------------------------------------------------------------- --------------- -'''-'-''-''-'��- --------------------------------------------------------------------'''--'�-'''-''-''-''' ------------------------ ------ Dm�� x�� �N/\L~!NSPECT|��N BY:---. -'-------. ---.� ----------------- ------------------------- U SAN JOAQU|N LOCAL HEALTH DISTRICT \ oo S""m American str°°* vnn West Oak Street 132 Sycamore Street *14 North "C' Street Stockton, California Lodi, California wm"*w°` California Tm*v. California � /� ,��"~~"