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y <br /> If �_ANITXTION PERMIT Pi/mrit <br /> 1611 <br /> (Pomplefe in Duplicate) Da ---- <br /> ' ' ' <br /> ��� - <br /> h �m 6 � San Joaquin | Health District form� n6 installtm work herein described. <br /> This . . lica ion is made in compliance . <br /> JOB ADDRESS AA LOCATIO <br /> ^------------------ <br /> Address-----fi, __ ...... '_-__'_______- <br /> Con ractor'o Nomo_- --_-_--_------._--___--_----_- Phone ._..----^__.._--- <br /> Insta|lation will serve, Residence g' Apartment House E] Commercial [:] Trailer Court [] Motel L] Other � <br /> Number ofliving units: ---!- Number ofbedrooms -,3--. Num6e, of6nthsLofo�v - �������'1. �� �?._-_._-..' <br /> 'r _r <br /> Water Supply: Pu6iic ��m �2- Community system �� ��� [] D�h toVa�, T�� -_ � <br /> ~- �~ _ <br /> ����.� soil to depthdepth �3 feet: Sand E] Gravel 0 Sandy �m � Clay Loam [I Clay �� �`� Ho,dpan � <br /> ' <br /> Previous Application ^a6e: Yes [] No 2�- New Construction: Yes [!?-No [l <br />/ <br />^ TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Nn septic tank o, cesspool pm,m{Hod R public sewer is available within 200 feet.) <br /> / �n 'y��' � <br /> Septic Tank: Distance from nn=ne`+ well ..Dixtunca from fo �otion-���---k4 L~c�'�.���.-.---.. <br /> � '`~ ~' corr.r~'--- ~- --- , ~~~, ' - Liquid --"- -�- --r—�/��-- -- <br /> . <br /> Disposal . .,., ~.'_.-~ .._. nearest_ � - Distance from foundation~ __ _ _ <br /> Seepage Pit: Distance to nearest well-.--------P ------Distance frpm f d f, <br /> - <br />[ El == Diameter--------------------------------------Dept"-------------------------------------------------_�^'quic_ypea.6i,v``~�~""`===°r`y�'"' <br /> c - .Privy:- ^ ~ Distance from'nvun,,+ well---------------.�.��..c--'�-.�-'�..''Di�~=���fro��~� earas �building---._-_------� <br /> Distance to nearest |o+ line''-''-',,,,-'''-''---'--'-�'-_.'------''-''''-''-''-''_'''-- � <br />' . . <br />' = �Remodeling and/or repairing (demzibe):---'--'���''-_-''---__--_--''-_.'--_----'_--''-_-.---'''__''--'-' <br /> � .----___----_'-'_------.___-__--_-__._---_-.__.___-_--_---_--_-_-__-_--.. � <br /> ---'---------'---------'--'---'--''------'----''--'------------------------------------------- <br /> --------------- <br /> ---'----' \ <br /> ---------'--'---'----------'-'----'-'---------------'-----'------'-------' <br /> - at \ have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. | <br /> | <br /> (Sign � s -------.-(Ownaran6/o, Contractor). � ------- <br /> 8v:--------------------------------------------------------------- --------------------------------------------------------------------(Title)-.------------------------ <br /> /Plot plan, <br /> ��Q � � � �� � �� � �� � �� �k�� ^� �n � �� � e�� �� ' <br /> FOR DEPARTMENT USE ONLY <br /> � rrruCx./Ov xCCcr/o/ o/'?-�-__.=°r=~`'~-.--------- --- ~------ -6. t----- <br /> D=E�--�-.-t^ �fcff��f '----- <br /> REVIEWED BY'''--''-'-''-'-''-'---'''-'---''--��'' -�� ------`'^` DATE.'~_''~_', ------------------------------------ <br /> --.-BUILDING <br /> ---'_---_-__--'---8U|LD|NG PERMIT |33UED.-__-------------------------------. DATE--------------------------------------------------------- . <br /> � Alh,,a+tons and/or ,ecommendafions:-------------- - ------------ --- ------ ------------_---�-------------------------------------------------------------------- <br /> ----------'-------'-------------'--------'--'----------'-----'----'------ <br /> --'-'-_''--''----_''--_''''-''--'''-'''-'''-'''---'--''-,�'-'''_--'-''''_-'_-'''''-�'''_----'-'' <br /> ~ <br /> '-'--''---'-'--'---''''-''''-''''-'''-'''-'''-'''-__'-_'''-''''-''--''_'''-_-'-'''---'-'--''' <br /> ------------------_---___------------------------- _--------------- ---- ------------------ <br /> ,. <br /> ' <br /> FINAL INSPECTION- 8Y:----------.lx�.+���(+�/��� Da+p-----'----------..---.------.. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /so s"mh American Street ~` soo West Oak s*re^* ~ 132 sv"°mmm Street 814 w"*h ^c^ s*°° � <br /> Stockton. California Lodi, California Manteca, California Tracy. California <br /> ES-9-2w /052 Revised W-z/oo - <br />