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FOR OFFICE USE. No. _ .............. ................................ APPLICATION FOR SANITATION PERMIT fermi+ .� , ...............................................-- in Dli tete / a i � I P� Date Issued This Permit Ex iras 1 Year from Date Issued i Or- ' Application is hereby made io the San Joaquin local Health District for a permit to zonj&l 11 the her A-d ri'bed. This application is made in compliance wits►C my Ordinance No S49. L1i63.-/ a JOB ADDRESS AND LOCATION ' ` ..' ........... f Owrier's Name... ...e7�J .................................... ........................ Phone. .: 1..�' ... Address..............- .... - �! - » - �_.._ :............. ..........».. -"_�....»,. Contractor's. Name.. ................... Phone....._............................. histalkMorl will Serve: , Residence 0 ,Apa nt House❑ Commercial ❑ Trailer Court 0 Motal ❑ Other aaat;K� r Number of living units: Number of bddrooms�+:. Number of baths 1._. Lot size Water Supply: Public system ❑ Community system ❑ Private gKDopfh to Water Table Arft. 4 �— Clwacter of soil to a depth of 3 feet.• Sand❑ Gravel❑ - San�y Loam❑ Gay Loam] Gey❑ Adobe❑ - Harc#Iaan, Previous Application Made: (if yes,dare...............n...) No -=New Construction: -Yes No ❑ FHA/VA:Yes 0 No❑ TYPE OF INSTALiATION'AND SPECIFICATIONS: _..Yw(No septic.tank.or cesspool per hitted.•if publirjsewarh;available within-200 feet.)_ _ _ ilw_ V Septic, Ta . Distance fro0 .m nearest well... �_.._.&Distances frorl, foundation._...1-4........Mat vial »_No. o#'compartments. ..'A_:.-'''`=-.5;ze-- , ; .el. ... ..Uquid depth_.__.`,1�-...... ..Cape p .. . Disposal Id: Distance from nears f . well. ........... .Distance from foundation-..1Q......__ Distance to nearest }ot�in®.__..... .... Number of lines..�, .....ie,..........Length of each line--- Width of trand ...'...._....._-_-_-..__...-. -Type of.filter materia9,_A ffl ......_..Depth of filter material-_-—f...._..__.Total length........ 4 ».................- a So ge Pit; Distance to nearest wel•I.-A#Rtq--------Distance from joundation....fp'.___.. is encs to nearest I in; �.... f Number of pits...1.................Lining material. _._-._.._ .-.-----Size: Diameter....0:51 ......... �-- --_--- b t Cesspool: Distance from nearest well..__.:-----•.....Distance from•foundation....................Lining material__.._------------___»..........�+ d SixesDiameter..........................'-°•_..Depth.._............ ....--••---...-------•---•.. _ _es_-Liquid Capacity ------� ---------.gals. ' Privy: ..Distance fr6m nearest well.....:............ ...............--........Distance from nearest building., --------• - �.................. Q Distance to nearest lot line../..._..-_ -----.-,._.�»�.--..._�.._ x Remodeling and/or repairing (describe):__.._,....,.- '-------.:,--_................................................... ....... i _........._.-._.......... - __.-..... �. -- -- R_. ».� ,......»................ i .........----•-------------•-•-•-.........................--------------- -- .....__....... ... - ------ -_.. _ .....�.»_.�-...._—»_.....................: I hereby certify that 1 have prepared this apprteafion and +hat the work will be done'in accordance with San Joaquin County ordinances, Ststs laws, and rules and regula['tons of the San oaquin Local Health Disteid. Alm 15gned�.. .-• - »». -----------lOwner and/or Contractor] (Plot plan, showingg sfxe of lot, location of-system in relation to wells, buildings,,etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....,.w- . ..__•.. '� s�• .. ------ •--............._._..-•-•----l-••................. DATE....-•----•....__..�..... �.---•..._.:.._.._._ REVIEWEDBY.........l-...---•----•--••-•-...--•-....,..........-..--••---•---•--•--•--•--•---•------..-•..-_......_:-------------- DATE---•-----.............. -••-.._... BUILDING PERMIT ISSUED.................!•...........................--------------- -.......- 1714TE- - - -:...-- -- =---..... Alterations and/or recommendations:-?................. - ------•-•----•------••--------...-_-----• . ........... ............................................................................................................... .� .............'----- .� -••....... .................`.....—•-......--..-_.-..._....._--•......._.»....-------- ........................................................................................................................_—-------...................................................._....._................ _:............. t ' NAL INSPECTION SAN JOAQUIN LOCAL'HEALTH DISTRICT 16011.tla:altert Ave. Sao West Oak Street 144 Sycamore Street 405 Wast 9f1i Street stocldan,eolifarr,la Lodi,California Manteca.eallferrila Tracy,Calirornio to 9 119VI6EO 6•99 am !-•fa i.P.CO. r