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FOR`OFFICE USE: A, ------------------ APPLICATION FOR SANITATION PERMIT.- . . Pernrl4 - �hii-'Paiir�rnit (Completqin- rcete) Date xsuecl_---- --.-•--------- .--- t E%jMs 1 Year in"EMfe Issued\ Applica#ion is hereby made the local Hyl. Dfs#tl t fora po nit#r�aSconstr'uct and install.the rein bed. This application is made in compliance wit�t ounty Ordinae��`°? i, X40 JOB ADDRESS A L TIQ .40. .. ..:" Owner's Name.. :... ... ... _Drone_:.... --•••- a .. Address- Contractor's .. :. : . ...i... ' st......... . Contractor's Name. .` .. .......... PMoris�: __ . Installation will serve: RasidonApartment Mouse [ . ,Commercial ❑ Trailer Court ❑ Motel" Other ❑ Number of'living units , ... Number of bedir61 onr ; Number= bat#is-'�: 'lot size " .-- Water Supply: Public system C] Community system ❑ Private afar f4. barpator of soil to a depth of 3 feet: Sand❑ taxeL _,Send q❑ Clay "isam Clay Adobe ] Hardpan Q Pres^Application Made:. (if yes,date.--_-- -----;-;l Na(] New �nstrugtion. Yes ❑ No ❑ FHA/VA: Yes El No[� Yf% OF INSTALLATION AND SPECIFICATION o septic tank..or cesspool permitted if puha sewer is ayai�" ��*W Septi a Distance from nearest well ....Dis#an from.foundation..' oundation ..ly ._ ater a(� x No. of compartments .._ .Size.yr _ i � Liquid depth_ Capacity: ... Dispos to Distance from nearest 11�! -----Distance from foundation . ' Distance to nearest Jpt line Number of lines__- ......20 -------- L.I.Length ofeachi line... -- Width of french...., Type of filter material....A&W Depth of filter tna#erial:_..., .' _.To#air I th._. _:.IL40-0.............. Sea it: Distance to nearest well_. - Distance 'from � dation....., .. . nearest Ibt f a i Number of pits...... -_ n ._..__Lim materiel. .. Size: Diameter.._.. th,.._.e cesspool: Distance from nearest well A.� Distance from foundation lining,rnaterial.......................................... ❑ Size: Diameter................................ Depth Liquid'E:apl�ty_ qhs x Privy: Distance from nearest well...............................:_...__....•Distance from nearest building..__. .... ..... . ................. ❑ Distance to nearest lot line................. Remodeling and/or repairing (describe)..........................................................---_.... .... =-- ....-•..... ..---. ..... ....... ........................... .................................................................................................... ......................................... .......................................................................::z.._.... .-._,. ......... ..............:..._. _._................_...�........F;a,..,..,.-.... ..... ........... .....I.. ......... .......... ... .....__ ....... ...._.._ ............................................_ ........, ---- 1 hereby certify that I have prepared this application and that the work will be done in accordenee with San Joaquin County ordinances, State laws, a, le: and regulations of the San Joaquin Local Health Distriet. (Signe- ....... 01!........ _ y. :. 1Ridfar Coe aictor) -- T - --- .('Title;.. (Plot plan, showing ize of lot, Iocation of system in to ion to we Millings, etc., can be placed on reverses FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 6Y __.. ..... ............. .Z!.. DAM— REVIEWED> BY................................................................................................. .--...,. ... ..... DATE --------------------- BUILDING PERMIT ISSUED.... DATE Alterations and/or recommendations: .•••--- •.....-- ---••• ......... ........... ....... . ....... .. ..... ,_................... -- FINAL INSPECTION BY:,�� .sl=` Dete..,!�l.'�IL L+......_ SAN JOAQUINLOA. HEALTH DISTRICT; 130 South American Street 300 Wost Oak Strow 124 Sycamore Street 20S west 41h Sleet Brockton,California Lodi,California Manteca,California Ter",Colifornia r ESbt REVISED 8.5'9 2M 5.62 ATLAS