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11'/� ~ � ~ � APPLIcATibN-FOR SANITATION PERMIT Permit No. ------------- ----------------- Application is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and i4a'Ilyh�e`wp_rk'_4e4 descrUid. This application is made in compliance with County Ordinance No. 549. -71"�t,a�& Contractor's Nnms_�.�°=�.�3��._-�L�L��.----_-_.----_----._-_.---_-- rnome_----__'----- l=tallationwill serve: Residence rtmentHouse Ej Commercial E] Trailer Court Motel Other E] Number nfliving units. ../-. Number nfbedrooms I+- Number of baths 1 Lotsizo �'/�CJ--_'----'--' Water Supply: Public system munity system [] Private Er--Depth m Water Tab kp_ ft . | Character of soil to m depth of 3 feet: Sand C-] Gravel [I { lay Loam 0 lay [I Adobe tr Hmrdpan C1 � Previous Application Made: (if yes,date--------- ---- -----) No [!o'- New Construction: Yoo«E'~No [] FHA/VA. YesNo � TYPE OF INSTALLATION AND SPECIFICATIONS: -� [N� wop�l� tank *° �e^^p�wJ 9mnx�*p6 � ��6Uc sewer is available within 200 feet.) -w � ' ' / r \ Se k` well-&'A co from nou,o`t *e|| Distance from foun6u+ion &p Material----------- ------------------------ ----------- No. .- mo. orcompunmonru-'-�^--.--..S.,"-.-X -" -'--"q"'" ~~p ^'°------'-'~~r~~-'/-~_ '- Dis' ~~ e|6: Distance from nmu,o,t ~*U/r0.,- Distance from foun6mMon-'/,{J..'--..Dis+uno line,-!- Nwm6�, of lines--- .. Length of each line---y_-'---�---. Yi6+h of french -_�--�.- —/'. '-_-Typo of filter mat' ---------Depth of �K*r mu+e�o|-1��--._Joto| �no+h-_5��-, --- ' �� Distance to nearest welll -- om foundation-1A.' to nearest lot U Num6erofpits----- ----------------Lining m ize: Diameterz .--- Cesspool- Distance from nearest waL-'--'-Didance �om foundation nafaruL'''-'-'-'_-....... 6i�� Diameter .�Deo� ` . Uow� Cup��. . __. � _ Privy- Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------ -------- [] Distance k, nearest ]of line`''---------------------- -----------------------------...... .'-_-'-___''__.__-''-_________� ' / Romo6eling and/or repairing (describe :---------------------------------'--'_--'-__----------- ------------------------------------_ ------------------------------------ -------------------------------------------------------------------------------------------------------------- `-------```-``---`--`-`-`-----'`--`--`-```---`- '-----'—'----'—'----------------'----'--'-----'--'-'--''-''----''------'--''--'-'''-'-'- _-.-.--_--.___-__'____'--__--_'-_____'-'----_-'-_.'-_.--__.''-_.'_-.-_--'---''--''-''-- | have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatio of f San Joaquin Local Health District. ` (Signed) --'----------'-'---- ` and/or' ' ! '----____ '''-_-'-_.'-_'-'�/ ''-'''''--'_------'-' ` �� plan,' �m�� h� � ��4� � ��. �� an he placed on reverse side). ' F OR DEPARTMENT USE ONLY l "PruC".~^.~ "CC",."° ".------------- - ------------- ----------------- ^--------------------------------------------- _ __________ ----------�__ REY|EWEDBY._---._-__--------._-._----*--_--__--_--_' DATE'.----..____-_-___--- BUILD|NGPERW[T |3SUED__-'---'-''--''--''--''�-'_-.-''''-_''-'_'--- urwE--''-'-_'--'---''--.-'--'- Alterations recommendations��nmnpnp. _'-~'---- - ---' '�� ---' -------'' , /1 -�l��-- L* �� m` c\� l�} ��^ --..z��-_------ / -_-�.�--°'��-_-.-' _._-'��^_-.----_-.. --___-- | _--'-'-''_'''-- ------------- '' ---------------------------------------------------------------------------------------------------''---''''-'-''-'''---''-' -''-'-------''—'--'-'''--''-''--'--'-'''-'---'''-'''— --'-''-''------'-''-'--'--'-' | -'---`�~'--'----- --''-'''--'''--'-''-'''-'''''--'—''-''--' | (` \ ` ' / �/ 1.�� �N/\L |NS9EZ7\{}N BY --��.."--_----'_�v~ ~~ Duto-1.�-�L--._'�-.�-.��-'L<^��-.x�-^�� SA�� JOA��U\NLOm��-7LH��f�}� D|STRICT ' 13vSouth American Street 310w°m-O"kw�° 1�*��m"�m�°� uwsw=,mhm=° �mm �no�,n�~� � � wa�� ~ �m�.�/�=� Tracy,California - ES y JJE.V15ED-5m9 uu n,62 ^r�^m �� - � ' �,1-41