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Permit No. lOi?�' <br /> .............. APPLICATION APPLICATION FOR SANITATION PERM.T tit <br /> ..---••-•... - <br /> .:., �Compfote•ln Duplicate) . <br /> Date <br /> _._.-._..... �r`� <br /> This permit Expires i Year From Date Issued a <br /> v y y <br /> q - n is hereby made lo the <br /> San Joaqu-n Local Health District'fore permit to construct and Instafi the wark herein desenbed`�F� b y <br /> icy+;on is made in compliance-with County Ordinancge <br /> e Ne 544. <br /> P r <br /> r <br /> -• <br /> C�+t•rl�r S Name". - � � .... .ys�� .... J.` ..._.... .... Y.wx +fr•. ��, ,�� <br /> f \ - Phone <br /> ill l r? i $ r ¢ <br /> �/ Trailer Court ❑ <br /> Motel Uther ❑ �z r,� 4„i. <br /> ;cr's Name^.....--.. �4 rtmenfi House ❑ Commercial ❑ : t7� 0/ f,:� , c <br /> Residence , Pa . <br /> rrrn will Serve: ,Lot 512e u <br /> Number'of baths; a! t /,ty y.3 ^ <br /> i Number;of bedroomse�.- � ' <br /> Number of living units: Private Dep}h.tci Water.Table ft r { F <br /> +ern ❑ Community sjrsterri d Adobe Hardpen.0 <br /> r'rr•r Supply Public syn -.. - - - - <br /> Sand Loam❑ ,Cley Loam Q `C1ay(] �,, 4 <br /> Gravel❑. Y N .FI�A/VA Yes <br /> .#'No p 'r <br /> :.,,zractar of soil to a depth of 3 feet 5an^I❑ New Corns+ruction Yes❑ <br /> r <br /> to ) Na Q <br /> ;�:-yViOiff Application.Made..:lit YeS•dQ ,..i. w� 4.� '�,- ,J.y n� , k't y�fr& ,,• - . <br /> y� S t <br /> Y iY1` t7FoINcTAcLLAklO ce RDa5p�mtledfCpN I!c e.within 2ll0 feet r� �r rY t� <br /> Bawer is ararlabl <br /> p q <br /> M +enol ............. ° <br /> DlStanCB from fpiJndatlOn CapaCttyw yr y !s <br /> C _ i 'p=stance.fram nearas+ wa11 S,Ze..:- Llquid depth a <br /> artmerts <br /> No of Come , i)rstanca`to neerest la 'liner a� <br /> Cr Distance #rom'foundatiasil� �`�// + <br /> Leri th of.each hntr.` Width of'trcnch asit'�- <br /> plstence.from nearest lQ <br /> i3no Diel g E,- i <br /> Total length QfdF z�t r ,.. <br /> Number of l;nas:.: - Depth o#.filter ma+eriaf f •- u ry <br /> E Type of fi4ter materia4 <br /> Dlstarce to nearest lotrUne L ` � . <br /> 2 "17 stance' o wrap Distant <br /> e from foundat,on <br /> wa r > c r <br /> neares+ S;xe Diameter <br /> De th . . Y r <br /> z. Se• .,l? P14 t2­ <br /> f"LSning material p xd f 1 r�1 '�-'p¢i " � <br /> x 9 Number or pits... <br /> Dista un <br /> from- nearest veil Di rice <br /> rom found dation <br /> Distance <br /> Lining materia <br /> Llqurd Capse gals rr4 <br /> u j+35i2e`Djameter . <br /> r 3 Depth <br /> Ds building.from nearest building �cski <br /> - I;tarice:"Trom nearest:w3fi' <br /> Frivy -5 <br /> Distance to near line . , <br /> I�-lI _ a s <br /> 4 <br /> RaR,�dQling and/or repairing �descn e <br /> _.... .. <br /> t .. ..... <br /> .. <br /> 'M1 <br /> ;f .., _ 4 <br /> -,.. ........................ . - <br /> 4 _ <br /> »� r w San oag <br /> ::::: :.., dC in accordance " <br /> s s <br /> tlo and,th t e }srerl: dl:bop 'j; n <br /> .....--.... . <br /> I here cerFifythat I hare,.prepared fl+rs'ePPrca .. a a Dig pct 4 , 4 <br /> i � a <br /> rules and regulationsiofhe San:3eagpl <br /> y lavesi.::and-ru ntract ` Y �+� <br /> ,r�.nbncerl StAta v 1 tt1 . C.a r <br /> e (Title} <br /> (signed}. w <br /> te:;'can bs placed oh.rererse'side�. <br /> f Byo .. • <br /> plan,showing size•of Jet location-of system in relatrori to f1s,`bulldme}s, <br /> r <br /> F0 DEPARTMENT us E ONLY <br /> N � <br /> .k .. r' _.... <br /> _ — DAVE <br /> --.N'L1CATIO*`ACCEPTED BY. .......- <br /> : DATE. <br /> .......:........ < <br /> 13Y...:. <br /> _... <br /> DATE <br /> I:y3cWED _ <br /> ..-.....- .._.-... ..., <br /> 81JILDWNG PERMIVISSUED...•...... <br /> y <br /> 7t <br /> -..._r. <br /> Alterations.and/or.recommendations:............... ........_..._..... ... .�, e "' : <br /> 1 ........................................ _................._ <br /> I: ._..----- <br /> i•:. _............ ...... <br /> ......•................. ........ <br /> ................... <br /> ., .... <br /> ........................... - ...._..._.... , .. <br /> - i .' ........-. ;j <br /> Date ' r <br /> t FINAL INSPECTION ••2�... i' <br /> ,q gQuiN LOCAL HEALTH DISTRICT 4, s >• <br /> 121 SY�ainare Slnd 205 West 9th Sreeei ; n <br /> ]00 Wen oak Street Tracy.califernla <br /> 1601 1.Has on Ave. Mangaa.California <br /> 1 Lodi Colifornia s r { <br /> 1 <br /> Si*ckfon.Califarnla d <br /> 7+k 5.67 Vanrruard Press - -. .-�•. �•++a4i <br />