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<br /> 'APPLICATION FOS SANITATION PERMIT Permit No �' r r
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<br /> ,Dupl-icated(Complofe m r � s�'�.S' Dafo e 1SSu^ae'-d.0„�1 "yx �rye ♦ K��'Y
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<br /> ;'plica+inn is hereby'mei a"to the San Jaequir 6o al Health.Disfrlc+fore permit io canslruGf and r all.the work hereEn destnb�d.�ar+
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<br /> s npphcdo in compliance With Cou fy 4rdrnance No."549 , , �Y� I
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<br /> EJB ADDI2
<br /> owE55 AND CATION <' E Y k
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<br /> �� '\CY Yt�l-Jic����•rk•:r �i'`K^'..y��'r��{s�r-�' :}�M,�r E
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<br /> i 5 r y t f �. F KN �C- "+`` 9.„� 'i`•.1..>R "rrrr
<br /> 1 .5 Conlrocjor's Name • z s
<br /> >.°,M', ..,r J• , S+yam rr° 2 _.tr :yy z '}V t i kf;'L� '�. : t�A "•t ?k-"'"ti i'c
<br /> 1;iz4,llalion will serve Residence Apa rmeat HouseY❑ �.Commerelal ©' Troller Court EI ;
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<br /> ri+ ,.s _ 4. :,..y0.x .t 'r' k..:• r a y 4 Fe7tir ti.�{; i x•;s 'h�"°t _ •s.'r -
<br /> Number of living unlfs ► Number of`bedrooms t4 Number of ba#hs ' Cot size+ A€
<br /> n }Ftikv� A 3,4Ni14 xNl
<br /> 1€!rt#er SuppEy Public-system;© Community system ❑ Pnva+e ' Depth +o Wafer-Tablef
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<br /> Chit. .. of'so;l to a dept h of 3 footv,,Sand❑ Gravel[]+ 5andy Laam❑ Ciay Loam❑ Clay[] fldobe Hare3pen F
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<br /> Pre,'• pplica+ion Made tYas ©'_No (� New Construct�ori i�eS fX1 O•Y' 9 i' r f�� y Xp
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<br /> TYI (3;„, INSTALLATION 7AND SPECIFICATIONS- ..:?r , ; � �, �y �K r ,`*,,': � �'�✓-;k�,,yy,,��py� ° „
<br /> Pi 1 sepfic Tank ar cesspool permat#ed h public sewer rs available vn m 2Q0 f =y r '-
<br /> : _ [ •.. � r.- }: r d v,'.y.5T f S. � � '"4+,'}`',, v ,�N'^� �. •r[�,.,. .. �dca-
<br /> Tank '•'-1JLsfance'frnm'nesrest well[/ -Drstanc from f u'}d�{lean '"� Mafen I
<br /> o of compartments _ Size _ IV'Liquid depth 'r _ � Cepetrfy 1.� ;,�a�`° •
<br /> istance`fr'o'm nearest well /��1�Distance from founds#wn �12., Distance to nearest lof II
<br /> i' umber oi lines ;::LenSf
<br /> th"of each`yllna' l) ���' Wid+h of�frsnc(, 4 y
<br /> 7 Type or.{iEter material�� Depth o filter malenal 1 Tofal
<br /> :. . . it: ':Dis+once ..`..: Disfance from:.foundation$g T�_D'ss#once #o�nears+lot lr e� P r'
<br /> SQP• !t f aM yL J
<br /> Number of pits Lining material .. Sae .Diameter Dep+h m
<br /> :-.gaol Distance.from rearsst well t.Distaisce fromfoundation Luring ma#etial 4t. x� 1u r
<br /> S:ie Diameter Depth f Liquid,Capaafy 7 r gals?.
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<br /> ri y: Distancefsom nearest eIl Distance from nearest buildingjjY $) yy� ,
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<br /> Distance to nearesfi lot line G_
<br />- '. �' - '':�'f ,;i;r.5?..!t- �''''''`` I `" :,'?r o t y `•ti-. l" '4s`� �r�i��t i��y��x
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<br /> aye re are his°d e�!'rcar+ion and That t5e' rk r ce ;
<br /> I hereby'certrfy f}�ot I li e p p PA Co ,
<br /> O';!nahCeS, Stat laws,and rules and regulations of_fhe,San Joaquin Local HealDisfrrct
<br /> �Sic}ne r:'.a l 'k:�f +�•rR r C'-t�t r_ f 7f r3 t.. t r t 4 „�(v`.L S�•�ZL�,r
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<br /> (Owner and/or ConfraeforJr;
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<br /> (Ploy .'c n, shLswing s1zt3 of laf; focalion of system in relation to walls, buddmys,`etc, can be placed on rara-se side) V,
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<br /> FOR DEPARTMENT.USE 0!.-1f•> �t:, :
<br /> '7777
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<br /> f r lGATION`PAGGEPTED BY-...
<br /> RE4ll`NTD BY. ......................................
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<br /> PERMIT ISSUED..................... .. DATE ;��;_� V
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<br /> r l!lAL IP SPECT ON BY:............... .. --'---._. ...... ......... Date ......... ._..... x> v
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT fr r f
<br /> 131 Soulh American Street 300 Wesf Oak Sfreef 132 Sycamore Street814 North *'C' Streaf
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<br /> 54ecSron, California - Lodi, Calllornia - - Man{eco• California - .Tracy Califo a' `
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