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_ APPLICATION FOR SANITATION PERMIT Permit No. <br /> D <br /> (Complete in Duplicate) " / <br /> Date Issued ---__3/�3,L`­-v <br /> pplication is hereby made to the San Joaquin Local Health District for a permit to construct and,install the work herein described. <br /> lis application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------- 2.....HOX---3.93-a--_Ripon.: -Calif,-----Al Is__ Tz"ack Inns <br /> ----------------------- <br /> Owner's Name 1---�111m®1ldinger----------•• ----- ---- ----------------- Phone__T81_ ,----9'.'59_711- <br /> Address------------ 2a--13OX_..3_93,9.__.4PqA--------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name---------------- 9!1U2-- 1APt----- -- ------------ Phone-----HQ' 3p°7- 7- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 4f e <br /> Number of living units: ___0__ Number of bedrooms ------0Number of baths".---?-Lot-size'3._"acre$____' <br /> I <br /> Water Supply: Public system ❑ Community system ❑ Private ®` Depth to Water Table Zd___ ft. <br /> Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamy Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Ej New Construction: Yes ] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tarik:F Distance from nearest well-_DEApIleDistance from foundation 2 _"'-MaFerial_"tC_,��'£ment- - <br /> I - <br /> ® No. of compartments--=- 2- - - -Size----41--x4-s-------i----------Liquid depth---31--------- - --------Capacity----$�Q---------- <br /> Disposal Field: Distance from nearest well .---_-Distance from foundation---_---------------_Distance to nearest lot line-_________.___-. <br /> Ensting Number of lines---------------__---------------Length of each line------------------------------Width of french-,--------------------------------- <br /> Type of filter material-------------------------Depth of finer material-----------------------Total length__________________________________________ <br /> Seepage Pit: Distance to nearest well_PP1-e______Distance from foundation--- ple__.Di t nce to nearest lotjine__amp1e- <br /> ® Number of pits-------9------------Lining material------rock Size: Diameter-----2 .__----- --Dep#h_-_10________________________ , <br /> /-I�esspool: Distance from nearest well-----------------Distance from foundation___________________Lining material__._--___._-____.____.______---.--- <br /> k i Size: Diameter-------------------------------------De th-----------------5-----•----------------------------Li Liquid Capacity-'-. als. <br /> 4.J ❑ P a q p Y-�- ------------------- g <br /> Privy: Distance from nearest well--------------------- t ._Distance from nearesr building------_-__.__:____.__-_____._.__._... <br /> ❑ Distance to nearest lot I;ne--------------------------------------- <br /> - -'----------------------------- <br /> Remodeling and/or repairing (describe):_______.._.-___adding---2-ce e-__and_---- epaga..pits to cafe septi <br /> --------------------------------------•-------•--••----------••--------..---------------fly-61-em---------------------- <br /> ----------------------I------------------I----------------- <br /> --- ------ ---------- --- <br /> --------------- --------------------------------------------------------------- <br /> ------------------------------------- ----------------------.---------------------------------------------------------------------1------,--•--••---------•------------------------------------------------•--- ----- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------ ________________ Owner and/or Contractor <br /> By:--------------------------------------------------,P.erry-...Warty------------------- -----------------------(Title) --- ------------- ------------ ' <br /> (Piot plan, showing size of IotTlocation of sysfeni'ki hifion`to wells, buildings, etc., can be placed on reverse side). <br /> F PART NT US2 ONLY <br /> APPLICATION ACCEPTED BY A - = = -- ------------- DATE- 3 <br /> REVIEWEDBY--------------------------------------------------------------------------------------- ------------------------------------- DATE------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-----------------------------------------------------------------=-------------------------------------------------------------------------------• ------------- <br /> .1 <br /> -------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------•------------------- -------------- <br /> ------------------I----------------------------- <br /> ------------- <br /> ------ ----------- -----------------------------" --------------------------------------------------------------....------------------s•------------------------------------------------------------------------------ <br /> ------------------------------------ -------------------------------- ------------------- - -- ------------- - <br /> FINAL INSPECTION BY:---------- ��- ------------------- Date---------__.--1�___-- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-4-2M 10-52 Revised W-2100 <br />