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^ 'OFFICE U-- = / �^� /-'--�-�� XpPLI -ON FOR SANITATION PERMIT Permit No. } � /. � (Complete in Ditiplicate) - Date Issued Application adSan'. Local Health District for a permitconstruct andinstall the work herein described. This application is made in compliance.with County Ordinance No. �49 Installation will serve: Residence Apartment Houseja Commercial E] Trailer Coutt E] Motel E] Other E] Water Supply: Public system R-Community system E] Private[] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Grave'l E] Sandy Loam 0 Clay Loam D Clay El Adobe trHardpan 0 Previous Application Made: (if yes,date---------- No 2r""New Construction: Yes 'R�rNci [I FHA/VA' : Yes F] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se t- T k: Distance from nearest well----—-----------Distance fr-om founclatiorlo--------------Mpterial___ est lot-line � -'p� --�lcl:- ---'- -Number of |ir nearest- � ��-----—---�� ' �t ofooc6 |ine,., --1 . --�n�«+stance from foundafion-,/O--------------Distance to near \ U Type of filter =ot;ri -.. Depth of GHur maforia|lr_�._---To+o| |ano+h--P--_-_-'_--_.. Oil "~ ' Distancetn ~~�- /O_� | |�e��-�'- `~~��'� Nur c� --- !(_.'___-Size:� Diomut�c -''-D�o+6/X- �'--_'--- � -- � U� Ceopoo|: Distance from nea're` -.:L'''-'--Distance from foundation... ----------'-Lining mofvri6L-- ------------------------------ 171 '-''-'--_.'_171 Size: Diameter------ -------------------------- --Doptk-----------------.--------------------------------Liquid Capacity.... Privy: Distance from ^o*�ot..v|L''''�- �''�--'---'''.-D�f ncofno�'�o6re�.bu�J�g.'--'--'-'-_'-'''- ' E] D�+once +onemno� lot line`-----�------------_--_-_-.__----.-_--_.__----.--_ ' �� Remodeling and/or repairing (6eyz|�):'�'--''''','-------------------------------------------------------------------------- --------------- ---------------------------------------- ._-___.__-------------------------------------------------------------------------------------�.--------------------------------------------- ------------------------------------------------------------ -. ------------------------------------------------------ -----------------------------------------.----------------------------------------------- -------------------------------------------------------------- � ��___._____��__-__-_!.._.-_-_--__------ ',-'--�- � --'-'--,------'--'-----------^ I hereby certify that I have prepared this application ` and th 'tha *or *M| 6e done in accordance with San Joaquin County ordinances, State laws, �nd rules andiregulation of the San Joaquin Local Health District. (Signed) . (Plot plan. showing size of lot, location of system in elation to weIrls, 6 ildings, etc.. can be placid on reverse side). F RTMENT USE ONLY APPLICATION ACCEPTED Ur--- -,------- ------------------------------------- DATE---a�v�.^��..��-._-__.. � REY|EVVB} DY'_''-'-'''-'-'---00 -'- -,-'''-----''----'-` DATE'''_-'�-'---'_--_----.-'- BU|U]|NG PERMIT ISSUED uA/� -__--.---_.-'..�.��--._-'-_--_--_-��-_�_-. ` --------_--.-_-_.__--- ( Alte,mtpvs and/or recommendations:-------------..-.-'__---_.--_------..-------_--------__.-- ' -'-_'-'''_''-'''''-''-'''_-''''-''��-'`''''--'-_--'--_'''--_''------''-------'__.'----'-----'-- ' -� ' ----------''-''----------'''-'''-'''--'''--------'--'''-_.''''--�'---'--_--'-_.''__�'��----''-''------ ^ . ---------------------------'-_'--''-''''^''---- ~-------- ------------------------- ------------------------------------------- ----------------------------------------------- ----------------- ----- ''' -----------'''--'_''''_''---''-�''-'-''-'''--_'''-'''-''''-''-----�_-------------------------------------------- --------------- / - />�. FINAL INSPECTION BY�'------- .1�_��'-'''-- Do�-�--'--./_ �� ''_''-_'-__- ��NJOAQU|N ��CALHEALTHD�TR�T / - 1601 E.ua=x""Ave. ovoWest Oak Street o*Sycamore Street 205 west 9th Strew Stockton,California Lodi,California Manteca,California Tracy,California e, oREVISED o'synmu^^ur.p.00. ' /