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rwmwrri%�-a uat; <br /> APPLICATION. -0A SANITATION PERMIT P6fml+ No, io 2 2--.2'als <br /> ----.---------------- ----- <br /> pie#& in Dupiedf! <br /> . .... . <br /> DalldW"toAstaLliguod w <br /> A 11'e"" k6fr96-Y Fn6db +6 06 Sha J68qulh Local Hialfk Miff; ahj <br /> T I ji I I R 16 for a wffilf +6 a6h0fue lhd%ll the work haft;M dese4ad, <br /> 8PP1'*e_& ;6h "§ rna" :h e6W""O W; k 061,14Y 04mefift No. 649i <br /> JOB AWESS AND LOCATION---..• A; <br /> ,00 <br /> . . ......... <br /> Add <br /> ---------- <br /> j060F666IF"i <br /> •k0illiRwi will wya.. Ratidane- <br /> M 8 APaicirmfi+ Ham C-6mmfift-I&I 0 TF61116F C6U4 C1 Me)+@l 0 <br /> Nurn6e 6f 11V1h§ ujil+i; Hurn6of of 6elfaarni -2,, Nuffi6of pf 6afk ;1.. La+ di6 <br /> WiffiF guokf. PU614le ty0cirn Uft�_ ;___P_; <br /> ........... ...... <br /> ff�bd* f6 WMof Ta6-6 ...zzzz ffa <br /> C-h&f"f of Sol' to& "Oh- 64 j hbfif 9'sR8 0 Gfbvbl El Swirly Lam- 0 06y L66rn 0 Clay 0 Ado66(3 Hard'ofiri <br /> Orew-416in APP11606ii Midi; (if New C-6hg+fud+16ri,' Y69 0 N6 FHA Ai Ye6 N <br /> fyft OF INSTALLATION ANb SPECIFICATIONS: <br /> (N6 ibPild +dfik of 6&10661 p0hilffe-d-it 15066 idw_bf N <br /> Set <br /> ia'Tok; from ria&mf MI.fafldd fF6r <br /> 6 fdl-nP-'F+rnjhf - _;..... <br /> a ::::NaN& ------ ....... <br /> I p-0 s--0 1 1;6 6;06hd6*6Fn1fi4dF6§+ w@jj___,9 <br /> from 40408fleo to hadf60 lot I1rt1§_4;V31 <br /> .......... <br /> U Fn-6§f af -------z;;.L@qA of eae-h of twi6-------- <br /> .. ........... <br /> ---------------? <br /> ......... ........ <br /> Ty�d 61 fi+df ::::::Depth of filfdf <br /> 6tal Ion . . . <br /> So6 <br /> iifandri to h6at6i+ W z; <br /> ------ +6 ii§aF6sf lot <br /> Num6rq' 4 <br /> f o i <br /> D1,06ft6 h=orn T6uf!d6fl6h .. <br /> ❑ 1z <br /> i <br /> Privy- Dist6nce ff6m.he&.rw weli�.................... ----­z:bjtfanc(§ ffc)Fn heamt+ 6ul Idie!9z <br /> ❑ <br /> ...... ........ <br /> Distance-t-o'nearest lot line'................... <br /> ..........--------- <br /> Remodeling and/or repairing (describe):......... <br /> --------------------------------------------------------.................................................................................. <br /> ............I..................................................................................-------------------I------------- ................................ ..................................................... <br /> ........................I.......................I................................................ ...............................I..............................---••••---•----•-----•••-•-----=•--•---.•.----------- <br /> ----------­--­-------------­­...............................................................-----•-------•••--•--------•-----•••------......----•---•-•............................ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San----J_o-"a**q-'u--i n-1County' <br /> ------- <br /> ordinances, Statelaws, and rules and regulations of the.San Joaquin Local Health District. <br /> (Signed)-------- <br /> --------------------------------------------------------------------------------------- WnGr an <br /> _­------- d1or -an actor) <br /> _7 <br /> By: <br /> -------- ---- <br /> ---------mf le)--------- ---------------------------- <br /> --------------------------------------------- <br /> ---(Plot plan;sh owing size --locaflon-o -syste ','a—,ej'on reverse si e). <br /> ow Ize of lot, Xw",Ia+lon fo we Is, I�u ng—. OZ. can be reverse_p <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------4,-2-&4 - <br /> 1U -'__'?9--)--------------------- DATE....... . z <br /> REVIEWED BY............... -- -- -- <br /> ------------------------------------------------**-------------------------------------------------- DATE_-- - <br /> --------- ---7 <br /> - -- -------__------------------------- <br /> BUILDING PERMIT ISSUED................ DATE---- ----------------------------------------- <br /> Alter#ions and/or recommendations:- ----------- <br /> ......................--------------------------------------------------------------------------------------------­.................................................................. - <br /> -------- <br /> ------------------------------------------------ I------------------------------------------------------------........................... <br /> ........................... .............................. <br /> --------------•-•-------------------------------------•--------------------------------------------....---.......---.........---------•-•-----------••----;.............. <br /> ..................................................... ------------------------------------ ..................I.............................. ...........­---------------------------------------------- <br /> FINAL INSPECTION BY,.,4/.!�� <br /> . .. ...................................... Date....�_...................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sweet 124 Sycamore Street 205 West 9th Street C, <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9.59 2M 5-61 ATLAS <br />