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m�o* <br /> _ ~ <br /> --........ <br /> APPLICATION FOR SANITATION PERMIT �nn� Nw. <br /> '- ` yn 0mp|�at� <br /> (Complete---- researrom Date |o*ue6 <br /> ' ' <br /> Application is hereby made to the <br /> 3up`errr�-Wo�constrwct and install the work herein described. <br /> This application is made in compliance with County Orcli�pance No. 549. 1? <br /> JOB ADDRESS AND LOCATION -01,1 <br /> ------------------------4..... -------------- <br /> ------------------------------------------------------------------------ <br /> dr' <br /> Installation will serve: ResidenceResidencer� Apartment House E] Commercial E] Trailer Court 0 Motel [] Other � <br /> Number of living units: _/- Number ofbedrooms '! Number Lot s1ze1�\��\..�m�..__._____.—' <br /> W�� Supply: Publicsystem [] CommunitysystemF �� DepthmWate Tu6� �efi <br /> -' �~�� � <br /> C���r � s� � m6�� �3 �� Sand Gm� � Sandy �� L�m � Clay [3 �o��] �mrdpana ' <br /> Previous Application Made: (if yes,date--------------------) No 'o~/ New Construction: Yes Z- No [] FHA/VA. Yes M--~No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> | <br /> 84o septic tank or cesspool pmnnHte6 if public sewer � mvmi�6kw��� ��� <br /> So nk� . 4�/� ancerom /^� Mate,rial - <br /> Uis | e|6: Dlstonoefrom nearest welINPDistance Distancenearest lotline � <br /> Number of lines-_. ' _--Length of each |i - oftm,mch-- .^.--._- <br /> Type of �tormo+m� [1Yo���- <br /> � --Dop+ filter - <br /> material-1 X_"_1 �not�' 2_��'' -----_-' <br /> Sen Pit: Distance to nearest woU-/��..^ --.Dio+on -le... <br /> ~---_Di�anceto nearest lot |ino-�---.- <br /> rtr^ <br /> Number of p��..�� _---Uning muto��| '�(/x��-- Size: Dk^metoc-:�� ^ --._Doo+h-..��^��/---- <br /> Cesspool: Distance from nearest well --.__Distance from foundation--------------------Lining material ------_._._ <br /> [] Size- Diameter--'-'--'''---'--Dept k ''-'''''_-'''--''-__-Liquid ----'-----gals. <br /> Privy: Distance from nearest well -----.—_--_--.. -----Distance from nearest building-------------------- . <br /> [] Distance to nearest lot line---'-_''''---'''----_'__.__.___.____________._______________ <br /> � \ <br /> Remodelingand/or repairing (do,c��� -------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> '_-..___._-..__'_-__._-.--_____---___._--_-__----_--_---_--'---_-__.__-,---' <br /> --------.--'''-''----.-_-''--''-__'--__---__.'_-''--'-_-.--_-'-_--'-_---''-___---_-''-_-�'— <br /> ,-_._._-.—.-_.-______,____.._________.__________________.________..__.__________- �n � <br />^ | hereby certify that I have preparedthis application and that the work will be done in accordance with San Joaquin County <br /> � , I <br /> es. State laws, and rules and re ulations f the San Joaquin Local Health District.- - . <br /> . � <br /> (Signmd)--_. ----__-.---..--- and/or Confra*tor , <br /> ''---------------------------------------- '_------- ........... � <br /> (Plot plan, showing size o oc ion of syste, in relafion fo wells, buildings. etc., can be placed on reverse side). � <br /> 3FOR DEPARTMENT <br /> DATE <br /> 8UiLD|NE� PERk4|T |SSUED' / --�� ------'--'' <br /> Alterations �p.e�,-"- <br /> -_-_-- ..,,..� ��.��l�.�`.»������_~_-.___..__._.__._____.___^_��___.________ <br /> ---------- ------...... ................... ''--''-'''--''—_------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------ ------- '—''''-'''------------ ------------------------------------------------------- -----------''-'''-''--'''-'----''---- <br /> ^ <br /> -'-''-----''-----'-'''-_-'''----'--''-'''---'''--''-'-''-'''--''-''-''_.-''-'''-'_-'-'--' <br /> . <br /> HN/\L INSPECTION BY:'---!���.-�L-��������------- Duto-.= l.�-...�--�—. - .. ---------------------- <br /> SAN <br /> . . . <br /> / ' ' / - -. -- - --- <br /> SANJOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street o0pWest Oak Street 124 Sycamore Street 20xWest 9th Street <br /> ^ <br /> Sto"m""'California L"m/.California Manteca,California Tracy,California <br /> cs 9 ncv/oso o'op xw v'*e ^rLxs <br /> ' <br />