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t- <br /> is - - ,:P'A f?.. ••µ i ',�F �_ r}'a..i:i 1_ r ' - -'� .��'�"f S °"�"' ' arj1''�'t"&' '' 'y ' <br /> F'qR OFFICE USE. ti k <br /> v � " <br /> V�. .. ................. <br /> ........... - t <br /> :: TIc7N;FOR SANITATIQN .PERMIT Permit No <br /> APPLICA <br /> f .... : ...... .. Complete i>t Delplic�ta) <br /> ( a g � <br /> ';•This.Parmit Expires"1.Yaa�Frbm•Date ]asuod tYtflssu�d ray <br /> ..............:.... ....... ......... ,D , <br /> Aizpf Ica}ion is hereby made to the Sen,lcaquin'Local FfeaMh Distric},for.a"rermi}to construct and Eni'rall the work herein described ` <br /> Thi; application is made in compliance with County,Ordinance No 549 <br /> ADDRESS AND TION <br /> a�.a.. _Frl,cr"S Name- l.. Ph Ofie <br /> op ./ Z.1 M,"� <br /> s, <br /> i s %.a»I ! + <br /> f R 4 ] <br /> ? <br /> Conti- cfor f •' <br /> .. <br /> fi 1 y <br /> lilitallation yriil serve Residence Apartment Ffou ❑ Cammeraal ❑ 7rallet fCour► ❑ Motel [jsSOther'[� <br /> F' •4 a ! e r�r� '+��s to �n�'7 yg y�'N" <br /> Numb <br /> of ,Eving Jnrts �. Numb®r of bedrooms Number of baths t Lot slxe �� ` <br /> F .,. t"_:t r. ,. sa it cin. k�x ik �PLly t e <br /> Supply Public sys+am ❑ Commur y system ❑ ,Private! Dep+h to Water Table ft " �• wa s ty1 } � ", <br /> ' C,,r"ctor of so11 to ee depth of 3 feet Send Ll_t Grevel❑'Sandy Loam❑ ,Clay Loam Ire <br /> © Clav O< Adobe 1 ardpan� .r <br /> tF _ .. <br /> r icu- A Ilcation Matte [ff yes date 1 No,❑ t New Construe}Ion Yes © N A/VA Yes❑� Oi© � �y r <br /> NS <br /> T�PE Q .�INes t eLtAank!O cesspool I P�IpPermithod ifICATI, sggwor Rs:available within,200 feet. <br /> I t ,rl� 8rk t_ Dist IL Dlvrancea tom fou :.,INI t ---.s+ �,, rc; •ti <br /> neares#'wet 'f" <br /> S T anCe frc, Irtments. �- •3L• 4 P .� P <br /> No. of compo Sae LI uid de }h Ce ace <br /> Distance from.neeresfi'well ' Distance from"foundation.....: distance to nearest,lot line <br /> Nuirlber of lines :. Length of:each line:_ Wid+h of•rbnc � } 'bra«', <br /> Ty of f,l+or`:matanal _ ` Depth of filter meterlal .. To+al length <br /> Apage."Flt ;Disse"rice:+d nearas5'well Distance from founds+Ion :1 ' ..Dis+ance.to nearest lo}6ne� '� "kj kin �? <br /> ❑ Number of pits Uning maferlal Sae--Diameter Depth r e T� <br /> %Pspeol. Dls+an" a fiomirieares+ welt Dis+once from foundation Lining material ` <br /> "1 <br /> Saes Dlamete�. ' Depth .. _... . <br /> Liquid Capacity „ ga15 `rw? f <br /> r'r;l•;': Distance from;.nearest.well Distance.from nearest building <br /> 1. o <br /> : plstance to nearest lot line '''''' <br /> n r o elm and � � ''J <br /> /or repairing (describe) ; <br /> T. <br /> ..............--• <br /> g. sr . fr u fYi 1 I <br /> I hereby certify that lye prepared:#his app cc tion and t a#the warE w'll be done to accordance with San .baqum County 5�F <br /> State laws, andtu#es.ind regu'latio!Is of the San Joaquin Local Health District <br /> 7 a1 t/i��E Owner^and or CalMractor)K 0", <br /> ."' ��I...;va f SE; Tic•.^ri+ KiK••SCR.v1C1•~ .................................. <br /> & , - 2915 E.MinerAvn.. • HO.6,1841 - ...... ....... - a I. �' t">•''-k' �' <br /> By. ....................................................... .. .._...: (Title) t 1 <br /> Ti <br /> plan, showing size of lot, loca+ion of system in relation to w6ifs, Inuildings, etc:,can be placed on reverse side) <br /> — --�. ~FOR DEPARTMENT USE ONLY 5 " <br /> Ar ! !'_ATIGV ACCEPTED .... ................:_...... <br /> DATE .. . <br /> a .. DAT E... .. <br /> Rs �'t.D BY. ........ -- ......................... ............................................... <br /> n Its NG PERMIT ISSU ...............:...:. .......-_.-... DATE <br /> _' t.!"ara'inris and/or recon.�lendations:.-.:_.....: ......... <br /> h <br /> .. ._._.. ._«_ .___ .-__ Y <br /> 1 ° <br /> ........................'-•__.................-__---....-......................____.._...-._-...._--...--....._..............:... .. .......::- .----... •.i;[' <br /> a - - - <br /> ,' .................. •---•_.--..................-.- ................. .................................................................... ......._... ........ <br /> - <br /> ..................... ...... .... ...... .................................................._.-..--........-.-...................................................... <br /> r <br /> :..:., Date..............�.�..���� ..... k"! <br /> a <br /> FI'.AL INSP�T�By:. .4u: `. ...... .--/..... ................ <br /> SSC JOAQUIN LOCAL HEALTH DISTRICT <br /> IGOt F-Haselbn Ave. <br /> 300 We.'Oat.Sir-1 - 124 SYcamore Street 205 Weri 916 E,r-11 t <br /> ' - - •- Lodi,Col!fornia Manteca,California Tracy,California l-•' <br /> great*",callhrnla f <br /> nws:o - <br /> k ' <br /> r <br /> , <br />