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, . <br /> � <br /> � <br /> APPLICATION FOR SANITATION PERMIT Permit Nu. <br /> ` nDuplicate) <br /> _-r�~.rr�� �. Date Issued __/���~,.. <br /> V A <br /> A�pplica-lion is/ he, 6v made the Sun Joaquin Local Health Districtfor permit � U <br /> fqc�nouctomJ inst, fhewo, horeim <br /> T 's application is made in.-compliance with County Ordkin))rce N <br /> Owner's Name-----------------------T------zl.!�----- ------- ------------------------------------------------ Phone---------------------------------- <br /> Installation will serve: Resi�lence W--_A`parfment House�E] Commercial Trailer-Court [] M0 0, Of4er 0 <br /> f living units: --I---- Number of bedrooms -73.- Number of baths j--- Lot size J-74 <br /> Water Supply: Public syst6m'[3 Community sysiem D Frivatelo Depth to Water Tablel-------- ft. <br /> Character of soil to a depth of 3 feet: Sand (] Gravel E] Sandy Loo' E] { lay Loam I-] t Clay El Aclobelg Hardpan El <br /> °-��� . <br /> Previous Application ��aJ�� Yes [] New Construction: /��«� No <br /> . � -- - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or.cesspool permittedif ' available ' <br /> 3 Tank: Distance from <br /> ­ <br /> ---------- <br /> No. of <br /> Disposal F�|6i Distance from no�es |���� <br /> K� Num�� � �� i th of french.of each line-. 'id <br /> Type -- <br /> or material--- <br /> -PIP of fi|}or m�xte�n'-' .7n+ | length-- � ^ <br /> ~~~ <br /> Seepage Pit: Y� �Didancu to nearest woL''--'-'-Distance from fnun6ot�n_'--'_--0btunce +o nearest lot |��_--_''- �0 <br /> [l P4. `Mum' be�r ofPits-----------------------Lining material----------------------- �Diameter------------------------Depth----.___--. <br /> Ce0000 : | Distance from nearest well —_--Distance from foundation-------------------Lining material '`----._'__ <br /> Size: Diameter'''''-'-----'--'Depth'-'''--.`'--''-''''''-''Liquid �Capacity----------------------------gals. <br /> Privy- , Distance from nearest well ''�-.--''--'--'--'--D�f nce fn6m nearestbuilding-------------------------- <br /> [� | Distance to nearest lot-line---------------------- <br /> Remodeling and/or repairing /6nmzibe):---''_-'-' '�-- <br /> --_--_---'^--_`-.-'�-^----_------_----..���.--��������-..����_.--' <br /> -------------------------------------------------------------- -----------------------------.------------------ --------_.__-_.----_---------------_-----.-----. <br /> -_._-_...__-'I_-----._-- -._---.__'-_.____'-__'_-- ­ <br /> I hereby certify that 1-have,prepared <br /> this application and that the work will be done in accordance with San Joaquin County � <br /> ordinances, State laws, and rules and regulafions of fhe.San Joaquin Local Health District. <br /> (Signe7 <br /> ..... 4�4%-- ---------F--------- -----------------------------------------------------'--,--(Owner and/or Contractor) <br /> (Plot planiowing si.ze of lot, location 'of system in relation to wells, buildings, etc., can'be placed an rever'lse�side). <br /> FOR DEPARTMENT USE ONLY <br /> o�` 'APPLICATION ACCEPTEDBY c~~- ^~- ~~ - DATE ' <br /> -------------- <br /> REVIEWED °. '�� �/�'E ' <br /> �.. _-'' ''-_.'__'-'---''''''---,-'-'—'-�-_.'--'''---'-' '-''-'''__.---'--_.__-'_ <br /> BU|LD|NG PERMIT ISSUED_---_--._�- <br /> -------------.. ---------------------------------------------------- DATE <br /> ' -- ---------------- <br /> --------------------- <br /> -' � <br /> DATE'----_.-__.--'-'-'_____ <br /> A�n,a|�noan6/n, recommnndat�ns�---._------ -----_.__..__—_'---.__-._--..___-__.---______� <br /> -------'_-'''_-''''_--'''-''_''-'-'-.-''-''-_''-_--_----�—'-''-_-.'--_''_-^_-.'----___._--- <br /> ' <br /> ' -'----_, _ ---_-''-'''-------_-�—_'^_.__.-_-. <br /> '-''__'--_'-'''-'-'-''''---'--''-'''—''--'_—'_-''-''---''-'''--'''''-'''__''-''''-'-.�--''-_'-.__---`_._,--._-__ -`---'— <br /> -''-'''''' - ''-' � ' '—''-'-''-'''-''-'-��_'�'_'�'-- ------------------------------ '-'''-'---'-''— <br /> )V <br /> FIN/ L INSPECTION <br /> .� --------------- ----------------- Dute-- ` —y ` <br /> .--..- ----------------------- <br /> SAN <br /> --__.—_SAN <br /> � <br /> JO^��'0N L(���LHE�LTH ��T�k�T <br /> /m south American Streof 300 West Oak Street /32 Sycamore Street 814 worth "C" Street � <br /> Sto"kf"" California Lodi, California Manteca, California Tracy, California <br /> ' <br /> ES-9-2m n"��a *�x/oo <br /> _ - -=. <br />