|
�. r-•Y--,. °.:,..... .�.'s .._ a * f- -•.+v+ a+,k'.n,h'S i ami;w.�. ^."..1:?'�." !u �t'kw-!t.( 'r�?`r?'y2�,lA•-:TI;�-��'�1� 1. MY ��d'+�.i
<br /> 'CR OFFICE USE
<br /> .. NITATION PER9tA1T Perm+f,
<br /> APPLICATION .IO>R SA $
<br /> This Permit Ex t;rose4fYnei?rrpllcafa} Dere,tssued
<br /> . . ..... . ..:... ..:.:.: ...:.. 1°rori: Date Issued,' t r as ti �:J� 4
<br /> App;ication is hereby rr.ade to the San Joaquin Local Health D st ,rt'for a per rt t constrnd arla i r�telr a wtark har`e,n sc1 Gx �
<br /> + T ��-Fri f� ti
<br /> This �pplicatron is'mada in compliance with Covnty_Qra nance No 5 �ti
<br /> ti a~ a
<br /> r'.. r`,L'DRES5 i1NC LOCATION:I1F , .: ADX �1. Telt' Tr+2,r9�f' rCs!..9�►/,D rte' 3a
<br /> is ame....::rllr ' ?hone . t� �`�f+P = kik' ;
<br /> ry Y
<br /> ! iia / a ��-�..�'"'�� C •es.
<br /> Can raciors
<br /> Instai>ation wdl wive Resiclen.... 1 rr i�mont Ho isle Commercial, Tra+lor Courfx Motel OthVT
<br /> er
<br /> r © Q err © K fi
<br /> ( ::Number of bedrooms Number of baths �-Lot sad I :
<br /> Numb P.
<br /> of Lv+ng units F F 3
<br /> i, tom .�;Communi 's stem' Private Da"th +a V4'ater fable-i�Q f+. `, 4 e r + + T �` ' ,
<br /> .;: Su}:�p,y. Pub c sys ©. tY•.Y ,I] P, " -. �p,ya, .,r •4 -,�."y,,�a�.' p<.;.
<br /> y y
<br /> ctcr'�f soil 4o.a.depth of 3 feef 'Send ] 'Gravel❑ .Sandy Loam Glay-Loam Q Clay Q AdoSe 0 HardpQn
<br /> ti loos /�pphcatron Made: (if yes;date 1 No New Cons ruciron Yes [� No �FHANA Yes
<br /> TYPE OF INSTALLATION'AND.SPECIFICAT10NSos''s "
<br /> i.,.,;, -�7� - A3p i' �t,rt tit-,-.,•d'�br� q... K4�'"y�Y ��°1'{
<br /> I• s we is ara:labla within 2fk�feet
<br /> s ool ermiffed if public e # .�:�•:• r
<br /> [No septic.tank"or ce sP P A a. -
<br /> Soptr 1 Tank Distance from nearest wel! D+srance trom foundet,on . .. . ' Materiel .'t "� x
<br /> f .. L ,{,. A 0TY�F A 1
<br /> F7 No oftompartr;ants Srze.`_ f Lrgtid;depth 'i4 GapaGty4" f` ^r" x,r
<br /> r bra 'k�s•<
<br /> Feld. Distance from nearesf well .]. Distance Pram #oundctron _ LD ,r Dista ce}ao nearest lot Ilne P '
<br /> r
<br /> Y
<br /> +r rS11r r a; ::Wrdtir of,french , i R C�'7 dvf d rF ? i -zl3
<br /> feu fiber of line's. 1 �. 'Length of each Line .. ,� r .: R� �r�-��jj� r � r
<br /> Type of filter,matenal K�r' �I�. Depth of filter material I$ Total length "F7r w ;
<br /> 1,
<br /> Distance to nearest well tD�stance from foundation D t3nce to,rearest 16tlrne� a r
<br /> r
<br /> I [] Nurri6er, of pits.: s Limrg materiel Sae Diameter Depth
<br /> f iesspool a °Qrstancs from-naaiest'well Distance from foundation Lining metenal
<br /> C7
<br /> Size:'.Diameter... :;Depth
<br /> ...... .; :.:.. - - "• �. ,. 0 d;Cap € P.
<br /> � � `81ar.. '
<br /> acity. ` g
<br /> ` ?-?•• Distance from neares+well ' histake from nearest
<br /> D sfar.ce to "oar st lot line r „. . r x .......................... .......,�x...
<br /> J.
<br /> ;mn.leli,g.avid/or
<br /> repairing
<br /> ..........` 1r
<br /> I f,!
<br /> ...........:
<br /> K
<br /> rs
<br /> ........«.. ;.
<br /> I h reby�cei4ify that I have prepared this applicatlo�and that tha worl wki] be done m ' cordance with San - oaqurn Caud4y '
<br /> 0.
<br /> Siate laws, and rules and regulafrons of tare San Joaquin Local Hcalth Drsirrct
<br /> C �,,, .r `.. 2�,Rs_—ti4� ( �er`and/orrCatfrallotu��}` ,. !
<br /> .; a •; A„L}'•3C4.x,,,n.�-.S.- i r 141e�._.+° f k,f .. <..a' 'e` T� -
<br /> h
<br /> .47
<br /> �/J� _ _� i -S y
<br /> ?P9o, plan, showin sixe of"iot, location of;s +ern. n relation to wells buildings, efc, can be placed on
<br /> g FOR DEPARTMENT,USE ONLY M 6 � F'
<br /> Z •
<br /> . �
<br /> `' DATE
<br /> rA�i BY ACCEPTED BY...__.... _�_1..:. `�---•• 'DA >� ,�7 � : ! ///^^^ y, �,3
<br /> 1 ArP " T �
<br /> '- B'.�',r i PERMIT
<br /> ndatkOnS: ..]_.._.. '..:.......'..�,. :. .:- -._....: r..... ^ATE .....................
<br /> � ..........
<br /> r
<br /> ..._..... r.'
<br /> - ....... . �> ��...' ,y, �.� :�•-s: ........
<br /> :.:... .:...... ............................................
<br /> xr
<br /> r
<br /> v� a
<br /> 1.
<br /> Date..
<br /> t 5AN JOAQIJIN LOir4ISPECTION BY:.
<br /> CAL HEALTH DISTRICT
<br /> . a
<br /> 1601 E.Natalie"Ave. 700 Wert oak Street 124 Sycamore Street 205 West 9th 5,;
<br /> Stockren,California _ Lodi,California Manteca.California - - Tracy,Coliromia S 7
<br /> :
<br /> - .. -... .. - ...:v .... - ._- „r - _-i r,. .. �.•, -4-is P,. die"?t.+.�I'y.:�$k,�•;`
<br />
|