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Permit No ------- ATION FOR PERM' . PLICATION C; SANITAT-1 Date issued (Complete in Duplicate) ---/------�"----- V to co/nsr ct and install the work herein described. ,�Joaquin Local Health District for a permit to const S41. Application is hereby made to the San County ordina e No This application is made in compliance ------------------------------------------------------------------------ - -------------7- ----- - -------- p�one ----- JOB ADDRESS AND _,TION- --------f 6 ------------------------------- D - 9 -------------- LOf ---------------- EN,.. ...... ---------- ------- ------------------- ------------------- Owner's Name------------- -- ------ ------------------------------------ _J----------------- 2 ----------- -- ---- ------ ------- Phone- ---- -------------- Address-------------------- Mofel [I Other. El Contractor's Name-.1-'}1Commercial 0 Trailer Court 1E3 Apartment House 1�3 COM --------------- Residence VT , ta 6frs Lot size __/----0----(/"-;Y\ Installation will servei - Number of bedroom1A--- Number o I ng units: -K of Number of living Private �_r�De qhs to Water Table-1-4-- ft- Community system 0 Supply: Public system 11 Adobe 0"HrdPal 0 Water ay Loam ❑El Clay ❑0 1 depth of 3 feet- Sand [] Gravel ❑[I Sandy Loam Character of soil to a I No 4- �ew Construction-. Yes E]No Previous Application Made: Yes ❑TYPE OF INSTALLATION aNDSPCTwailable' ifirlin 200 feetZ,(No septic tan.k or cspool pe ad if public sewer is av rmitte Material_,011� --- i nearest well__ i",Distance from- founclatio -------- ---C-a-pacify---- ---------- Sepfitc TaRK C;istance from neSize -TL Liquid deP6___,,_,, No. of compartments'-__' ------ Distance to nearest lot line =------------ ------------ -h ----------- Distance from neares,�;V ell_--(-__-----_Distance--------- -.Width of trench------ -IF-; V� i ell 6d Distance f,ro r _? ,,sal Ri Of each line----- , ------------------- Dispos Length —-------rotal length----- -- ----- --------- mat Depth-of`filter m T�pe of filfe�,_mate --- nearest lot line----------------- kr`ce from ljoun�afion-------------------Distance to ge Pit- Distance to nearest well---------- Size: Diameter----------------- Depth--------------------------------- Seepa Lining'_H�ateria�-----------------------I ------------- N'umber of Pits----------------�- t . T-1 Distance from foundation_------------------Lining rnafer;al------------------------ 6isfance fromnearest well----------------- - -, --i -------------Liquid Capacity---------------------------gals. Cesspool: -------Depih--------------------------------------- f, 4_��; � Size: Diameter,------------------------------ -ng-;---------------------------------------- 0 1 1. ��- Distance froe'neae9t'6u"61� prjvy:,� ----- --4----------— ------------------------------ ___j�___---_D;1stance fromi Distance to nearest lot line"-- -------------- El ----------------------------------- ---------- r1pairing �cle_`cribe):----------------- --------------- -------- Remodeling and/o, ------------ ----------- ------------------------------------------------------- --------------------------- ------------ ----------------------------------------- ---------- ---------------------- ------------------ #I , ___:....5� F---------------------------------- ----------------------------------- ------------------------- ------- ------------------ -------- ------------------- an Joaquin County ---------------------- -------------------------------- i will bedone in accordance with S ---------------- -------------------------------I--------------------p_-_---------------- ica'tion an that the work ------- I her certify.that I have reared this aRp 11 Health District. i laws, and rules and regulations of the Sal Joaquin Local ordinances, Statelaws, to ancl/ Contractor) ordi w Ce,7 tsig --------------------- ------ ------------- etc., can be placed on reverse side). ned)--.---- -------- Title By:-------------- six' of lot, t9cation of system in reia4ion to wells, buildings, (Plot plan, showing e 4 11 DE111A i MENT USE ONLY .............................. .................. 3 y-- - - ---------------- DATE - - -E I -------------- APPLICATION ACCEPTED 1 ------------�- --- �- --A— --- --------------------I--------------------------------------------------------------- ------- REVIEWED By--------------------------------------------------- - 1 K- --------- --- --------------------------------------------------------------------I------------------- ---------------------------------------------------------------- BUILDING PERMIT ISSUED------- ----------------- -- - ----- ----- -----------:-- Alterations and/or recommendations:-�------------- ------- ----------------I----------------- ---------------------------------------------------I-------------•------------- --------------------------I----------------------------------------------------I---------- ---------------------------------- -------------- --/----- -------- ------------------------ ---------I--------------------------------------- -------------------------------------------- - ---------------r_1--- ------------- 1�----------------- --------- --------------- --_- - -1------ ---------------------- ---------------------------------------------- -----------------------------------------------------------------_-_-_ --- ---------------------------------- --- --------- -- --- -------- --I-------- FINAL INSPECTION BY;_-_-__-- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North -C" Street 300 West Oak Street 132 sycamore Street Tracy, California 13o south American Street Manteca, California Stockton, California Lodi, California Revised W-21130 ES-9-2M 9-51