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<br /> ... ` APPLICATION FOR SANII ATION PERMIT Penrit" No.'..f���f'•?.
<br /> (Complete in Lluplicnte)
<br /> ................ ..... .. ,niS Permit E l ,
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<br /> . . .. .�--� ��ps 1 Maar From Dbr4 Issued : -- Date issued 1'! Io
<br /> Application j:hereby made to the San JoaciC, Local Health District for n permit to construct and in'fall the wort hererrdescrbed w
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<br /> This application is made 'n corr,piia.nce wi'% Ctvn+y Crdinancp No. 549. Zz `
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<br /> JOB ADD A LOCATION-.
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<br /> Ct•+ner. No"......_ -... :1?I¢:�. .............. .... ........... E--
<br /> Addr ss
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<br /> Phone
<br /> -. CM'FtreC+pr•S 1�a1'te...,.-..„.._ .._f�,.4�V.�a+ ............... .. .•. ....-.................--_•............. ...... Phone-,
<br /> irrniaslatian w:A serve: Res-'�:rce �rlpartraent House © Ccmmarc;al 0 -Trailer Cour:-❑- Mote! © -Other �]
<br /> ":umber of living units'.-I-. Number of bedroorns . Nurnbe at baths -.�.. Lot size '/�`"� �Ij7-77 c f'
<br /> 77.
<br /> Water Supply: Public system © Cammurii+y system 0 Private [9-bep+h To Water Table .�J�ffi i
<br /> Cl�arector at sol to a depth of 3 feet: Sand❑ Gramme''Ll Sandy L.oam❑ C',r Loam[�Clay[] Adobe o] .;,Hard
<br /> Prerlons Application 4
<br /> ' Italian► Made: irf yes,date---------- -- - 7 NQ �' Nov„Construction: Yes ❑ 'No f8�FHA/VA Yes[]' No' y "T y,r�i.
<br /> Tr E.Op INSTILLATION AND Sf'cCIFECATIONS:
<br /> (No seatie fa*.i or cesspool permitted if public sewer is available within [OC feet ,o,q"'
<br /> Sep}i< Te-r D;stanca from neared wail-..f.�O.�l is.ance nom fcvnoafion....i ff,;Matenal.:(�•�„r fJ(r +r;
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<br /> No. of compartraens>....�... ...........Size. � Lsquid depth....yr!�...-......:Capacr
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<br /> Disposal Field - Distance frcm nearest I. /QODistance from icundatj n... -.
<br /> Number of.lines.......... Len th of each line........
<br /> " 'Width
<br /> nears o
<br /> X7 id#h of st }
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<br /> £ T of filter maferiai.. 4..�, g .Q W _
<br /> trench '
<br /> Y [3ep+h of filter rrt eriel..� Total lengthy
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<br /> Seepage Pit Distance' to nearr,s+well-�0�..--..Distance rry}� fau�dation.... Dl ante to nearer lot l,ne'��� �L
<br /> �! Nurr,rrer of pits._.
<br /> Cesspool: Dstance ;nom r.4are t was! Dista.-'see from found3+ion..... L,mn maternal
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<br /> i. . Sala: Qrometer--:. ..... Depth.:....... ............. . 1 rqu d Capaaty , *
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<br /> Pr,vr Jstance from nearest well_ p;,'.arce from neerast.bu'ld,rg rfm93 �
<br /> ❑. Dis+ance to nearer! 'o+
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<br /> Remodeling-and or ieca;r; q d scree;:, �ali� ...L�,d.7fJf.�rf' j�/T✓:.... 2( G� /77 �'1��'/ yl i !
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<br /> } bereb certify that 1 have preparosr'ini: .spp11Gelion and ions} the -oris will be Gone'in ectortl rce wth $en Joegwn C.ovntjF,
<br /> ordwances. State laws, and ruins and reg�latian; of +Ire San Joaquin Local Health District,'.
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<br /> (Sig {c,�r»e gas €s St 1
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<br /> i� .rte -Fa �u
<br /> rrhatlor
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<br /> f pian, showing size of lot, location of sv�larr. in' la+ior, to wells, builcling:, otc.. Tarr'be prafed;on reverse
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION A::%:EPT EC 3;
<br /> REVIEWED BY.......... ...... .. . ..... . . � ....... ... DATE ...............
<br /> BUILDING PER
<br /> t1!T ISSUED.. .-... ..: .._._--..
<br /> Aheratia�s
<br /> an recam enuat,ons:
<br /> 1 I -1 tj�i y DA -
<br /> aaII ............... ... ... , . ..... ........ ..
<br /> FINAL I`SS?fCTiO:: GY.. �1'. X. :C r. late. �..L �r l7
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<br /> SAN JOA,r}UIN O—AL H,EAI r'� DISTRICT.
<br /> Ilb io,::.`.�-*,icon S',m- 300 Well 00'.5-•wn ;"e4 SytOMare 5+rser SDS Wes?01h:ilnet
<br /> S,erLfe�,tcl•!ernia teal, ;a!;i�•R,a +yQ n,*p3,Ca!il0rn iu
<br /> Tracy,eelifernlo _
<br /> E5 9 7FEV19lJ L,•5+ z`? :•63 4TLA'' - -
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