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m' */ APPLICATION FOR SANITATION PERMIT Permit No. (Complete � C�n�� ` ^'' '-` Date Issued _...�.��/..{"�� ~ . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein � This application is made in compliance with County Ordinance No. 549. --- Owner's '~~ | --_---'--'-'-----'-_''----__-- , , ' . p� �� �onfmcho/� Numn-. -----.--_. one.��.r�.�'.-.��-.�. ---- Installation will serve: Residence Fl- Apartment House [] Commercial E] Trailer Court . Motel 11 � Number of living units; a*' Number of bedromms4- Number . 6o+h, size - ��_'-'--_ � ' n��rr� Wafer Supply: Public �� E] C�m�� n �p�� o =pfh to Water Table -- ft. Character mfsoil to a depth of 3 fao+; Sand [] Gravel [] Sandy Loam E] Clay Loam Ej Clay [] Adobe E] Hardpan Previous Application Made; Yes [] No 2�-- New Construction: Yo, 6-~^/o [] - TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No vpp+iu tank or cess por,n�Hw6 �� public sewer is.-available~�6|n 200 6oef,) I ^� ^ - -- �� - �3 ptiTank: Distance from nearest we||''~ ~-e -`D�u�m^ foundation''on--yua--'Mi | Nn. o{ compartments--.-�2—----------Size---Lj*0~?6^.Uqui6 6epjk- --------------Cupo6|y.elo-49--- ispnsv| line F/o|�� Di,tun�o from n�mrest v�U-----'D�sfunc� from fnun�ofion-------Di�toncv to nrnnas+ lot |ino. ---- � El Number of lines----------------------------- -----Length of each I�ne----------------------------- Width o[ franch----_-------- _ T,pv of C�vr material-------------------------Depth of fi|hy, material-----------------------Total length------------------------------------------ U ~ � - Seepage Pit: Distance +o nearest �� .' x��-^-D�dun fo � --��L' Di *o nearest Number p�fn-' �� --.Uning muto�uL S�� Di�mofec.� ��.�- +h -Dep - :�0.�=----. " Cesspool: Distance from nnon�+ wuU_. ''�'-Di��nco �om foum6ut�n'-_''.'�_Un�g mutv,�L''-'---'----_-- � '-�� -meter ��'.==��-,`, ~~----�'- - --- - -- - ' -- / Privy: Distance f,nm nearest well------------- --------------------------------- Distance from nearest building--��---_------� ~ �] ��nc� fo | ..�,,.__`,-_.__..,-',-__,--_ �="��^~~,_�,,°~��.��._��_�=_� =-,=�� - - - | Remodeling and/or /- i 'ng (6 ' ~be):-------'__--._.--__-.-_--___._--.-._'''_____.____________ | .-__'---___.-----.---_-____-_-__---___'---.__-_---''-'-''_-----._-__-'''-'''---.'--- . - .-------__-.--'__--_-____'-''-_-___..__.-'_-___.--_-__-__--_--'---_-'-_--'''---'---- ---------------------------- I hereby certify that I prepared this application andthat the work will bedone in accordance with San Joaquin County u ordin.ances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).... ~ -----Nn - (Plot p|an, showing a6m of lot, location of system in relation +owells, buildings, etc.' can be placed on reverse side). ------ REVIEWED -/,,-,,FOR DEPARTMENT USE ONLY BY ,� �- ' DATE� -- ---------------'' 8U|L0NEPERMIT |SSUED_---_-___--.-_------_--_.-_----. DATE------------------------------------------------------------ Alterations -.. AltarutiwnsaoJ/nr ----------------------------------------------- ------___________�___.__._.____.__._______.___._____ '--_'-''_-''-''---.'''_-'__''---'''-''''-'''-_,'--.''-_''-_.''----''----'-''--'_-.__''_-.--.'-'- '------------'-------------'----------'-------------'-7=--------''------- . '-_--'--'_'---'_--_''-''''_-''-'''-'-'---'-''`-_'----''''--''''-''-`_''_-''--'_--'''-'-'-'-'' ' ' '-'--' �_�_��__��__ -------- FINAL INSPECTION DY�c��x�--.-.-_----------.. ---- Dofe--.�[../.--'_.+�----_-------' ~ � SANJOAQU|NLOCAL HEALTH DISTRICT oo South American Street 300 West Oak Street /sz Sycamore Stree414 m"*h ^o^ Street 0+"=k+o". c"|ifo=i° Lodi, California Manteca, California Tracy, California � ES-9-2M .o'^u x"./"°d v/'2/00 �