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,: gar•ten l
<br /> 17,
<br /> t ?ermit +�
<br /> APPLICA'T`ION FOR SANI�ATlC�N P�RMIf
<br /> 1 (CaMpl,sfa tri puplkataj � Da'kla .Issued � � � �'���°
<br /> :� r x .^a -rs h a r rJ r _ F, ssa c.' •+'
<br /> '�,
<br /> yew •` ,
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<br /> ati'or. r,hereby made C, jhe 5an'Joaqum Local Hsalth Drstnct.for a permr#to cons+ruc'and ns+all the work heron destnbad a ti
<br /> ai ligation is made in
<br /> compliance wt#h Coun#y,Ordrn No 5491
<br /> ' OCAT€aN .. ;� war,
<br /> ,
<br /> a ADDRESS A
<br /> �' €IOne ice'•
<br /> _ Naar Nam fl
<br /> ' Addna : d '' y Phone ,
<br /> 4 rt r 'r
<br /> C;3fllrocto NameMOtca€ .Othefy
<br /> a$ rcrai L7 ,Trailer Court-[� ,�
<br /> msnt House Commie M
<br /> In5t71a}ion Wtl1 SaTVa i;esrdaztite'❑ ' Ap , �. , r Y ,y ..SW r;
<br /> moer,o� living tJn is . Number of bedrooms Nrmber'of baths Lot sae .-
<br /> s. t y
<br /> I'riva#e Depth t0 Wa#er Ta n„ drtlyi 3i` �IF:
<br /> Publ c system ❑ nrty'syste
<br /> m ❑ l� - u i i t
<br /> r+�r:,> supply: ' Commu ` t � i • ,
<br /> dobe
<br /> l' ' ' r;ilncacter of sotl to a depth of 3.feet `Sand[] Gravel Sandy Lgam Q Clay'Loam© Clay,:© `�n r 4� y ;
<br /> Nevi Construction :Yes'( No ❑ FHA/VA Yes❑s ,No
<br /> Previous`Applica#ion Made Yes Ll No l
<br /> s ...
<br /> TYPE'OF MSTALLATION.ANl7.5f'EC€FICATIOIS F f �
<br /> t, 4
<br /> (Na septic tank'or'crupool permitted if,pabiic ser er is evailab€e},within 2fl0 feet) i _,•r x,ti ; ,
<br /> E Distance o fours
<br /> #rn.... i Mattel
<br /> c Tank Distance from.nearesi ;well � �-
<br /> Sae . depth Capacary= ,
<br /> No.'of compartrnerts T ti yGS
<br /> } S 1 1 ti
<br /> Distance to nearest lot,PR ,,
<br /> ,�r oral Flold Distbnce from,near°s+ well �f' tstancs from foundanon ,
<br /> j , Len #� of each lme: L2
<br /> f Wldth:of trench: �r k1
<br /> r Vumbar o lines 9 uta€ GBn �hti ,� s
<br /> TYPe.of(:Iter irlaterral,,t•f Dep n of'fter.material . �j,✓ '9 k' y ti ,�'s, �
<br /> • t - u ir4
<br /> r, Dlslance to nearest well i 'Distance from foundaticn.:.:. ..Distance#o nearest Tat l ne a^5
<br /> St:epage,Plt _ D8 th
<br /> N3 mbar of pits Llning material Sae Drarne+er P x �,1
<br /> ° Lining matene€
<br /> Dlsiarce from nearest well Distance from foundation0A. , r
<br /> Liquid;Capecr
<br /> r 1_� SiZe.-DiameterDepth r '� kikel7 ,'::FtS7:v 'r,'
<br /> ' Distance,from nearest building�
<br /> Drs+once from nearest we[I
<br /> i Dsstar e�{o nearest€oi Irne
<br /> f•VV: , 'e t i'e,' •,. ;� ai y�'r-� iW {r7
<br /> F.n delin anc�/or ape:ring: dos be}
<br /> �c�►.
<br /> ----------------
<br /> + t Z} 1 „Y'
<br /> ....: " s' Yolklk
<br /> ...
<br /> G' accordance with San JoaquinCoslr � ��;
<br /> hereby eer7tfy tha# I have;prepared+iris:applicatiori,aria:t€�at}he'work will be done to
<br /> State laws rulos and regulations of the San Joaquin Loeei Ftealth District
<br /> _ 'j attar �k
<br /> ', •:_ v� ,n y l j� <.l.a ( J'x3 �w119r an��O�r�'+Or1 ` � � � '.
<br /> 7 iTrtleJn
<br /> {
<br /> (f t glA showing sire,of lot, location of system in relation to we€s buildings etc;'can be placed an reverse side}. r jar.;f �r ka
<br /> — FOP DEPARTMENT
<br /> USE O ? �
<br /> - —
<br /> KATION AC'CEr TFC' aY.::.
<br /> o DATA .�
<br /> . DATE= Y t
<br /> ............... I- µ
<br /> ED
<br /> DATE I71 dG.PERMIT.ISSUED.......
<br /> Alteratiors and/or re onmendations ••••••-•••••----
<br /> .. __
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<br /> ,
<br /> T1
<br /> .... ..Dt .
<br /> - 1 i NSPECT#ON B ........ ........ 1
<br /> - SAN-JOAQDIN LOCAL HEALTH NST�tCT
<br /> �D y
<br /> alb hlor4k„C,,
<br /> 300
<br /> we Oat Strllbf 132 Syeamdn 5fnd
<br /> :36 Seuth Ameritert Street Manteca, Gnlilerni� Tracy. Gl3fornia W'?'�.
<br /> Stockton, Galif?rni� Lodi,,California .
<br /> }. _q Ravi"a 1.57 F.P.CO. ' t
<br /> Fe:..E,x �l rr .:<,Le.:'r. ....t....'r..,� �.. _... a': xr.,
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