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/[ APPLICATION FOR SANITATION PERMIT <br />� <br />(Complete in Duplicate) <br />Date Issued <br />Applica+ion is hereby made to the San Joaquin Local Health District for pomnif to construct and install the work herein described. \` <br />This application isImade in compliancewith County Ordinance No. 549.~ <br />J<]8 ADDRESS AND LOCATION -------------- _5_1 ---- -----------.y <br />---------------------------------------------------------- <br />[wmo/, Nume---.-z�� '-- --._--`Phone -._..-`-.__'__'- <br />A66,a' <br />o_-.___'-�'�.�_____ <br />Contractor's Nume'.'-- --------- � ._� <br />r��''_r|w` , .. <br />� <br />P^_h_-ov <br />-__--_._-.--. <br />ation <br />,-__-_'-, <br />Insta| will serve: Residence ,hnen+ Homo E] Commercial [] Trailer Court [] Other <br />of |�| units: ' /~. Number of bedrooms 4"Number of baths - / Lot �ze _- ---'-- <br />o <br />^« <br />L <br />�^ <br />� <br />� <br />W� Supply: Public. system ��mun� system � Private E] Depth to Water Table -_ ft.��d��o� �u don�%Jof3 feet: Sand �m�.L�m� C�yL�m[] Clay E] Adobe ��n� <br />Previous Application Made- Yes [ No �Nw Construction: Yes <br />TYPE OFINSTALLATION AND SPECIFICATIONS: <br />(No sept�ta k' cesspool Mfn6 � 61available -'.~ 200 feetj <br />Septic Tan <br />'k: �of"b ----------- Materiai --- r Re C_( - <br />No. of compu,nnan/� <br />Disposal Field: <br />m ^er w / U'~ �i�pe of ��� material-- -`r.^ /f ��r mu~.'--''��| length --- <br />Pit: Distance to nearest well ----------------------- from foundat�n..__.._--Di�once to nearest |nf line ---_-- <br />[] Number of pib-------Un�ng material ------------------------ D�mater---_-.-Depth ----'-___.-- <br />Cesqpuo��is <br />�tonce from nearest woU�-----Di�ance from foundation -------------------- moha�oL------'__.__ <br />66e: Diameter------_----..Dop+h_-^------------..L�mi6 Capmchy'-__-_.__-gals. <br />Privy: Distance from nearest weU_-''--''--''--�'_.-�.Di�onp: from noon�f6wU6�g.'-'--_'-'--'__'- <br />[l Distance to nearest lot |��'''--'--'------�---'--_ <br />Remod�ing and/or repairing (describe): --------------------------------------------------------------------------------------------------------------------------------------------------------- <br />___�_.__________._______.________. ' �______._________________________._.. -------- <br />�_�_��'�����___�^_�__������������'_������_��'����;'�������'������������������- <br />.___�____________�_____._________�_.____._______,.__.___._____.________.__.______.. <br />7 A�andd <br />—���������' <br />-''-~-~-^-~`-`-~--'-��-------—�--'—'--'------v~~'~"'"x~ 6="""`'=/ <br />8v�_'___--L_.---'_-'-_''''�-''--'----__- '-''�_________-------------------------- <br />------------ <br />(Plot <br />_______________ <br />UMof�an. *�e^wf�t location of oynhom in relation fnw|�buildings, etc., can be placed on "o,orye �6�' <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED 8Y.'___- '-_.''' DATE _---------- <br />REVIEWED <br />�� <br />REV1EV8}BY--..__._-----_.----..-------._----'---_-__-..DATE-----.___.____._. <br />BU|LD|NG PERMIT ISSUED '-_-''-''''-'''-'''''�-�''_-.-''''-'''-''''-- DATE--,-',_--_-' <br />Ntw,af�nsan6/o,nvcommen6mNons�-_------- _----- ___..____ __________--_ <br />-------'---------'------- ---A-��.-.�&A---.j1�4 ` ______.__--.. <br />--_--_---_--'---_.------------�----'------'----'-------`Mi� --°mAw�r''-'' <br />----_.'_-'-_''-'--''---''-''�-+-''-''''--''_-''---''_.-'-'''-''''_wioq--* -- <br />------'-�� ''-- �'' ''''''-'''--''-'-''-''--''---''-'''--''''-----'--' <br />Date ---- <br />FINAL (NSPEZT|ON`BY�.:-3---�.��',---._--' <br />SAN JCmQU|N LOCAL HEALTH DISTRICT <br />/so South American Street 300 West O° �=° /so Sycamore �=* m* North 'Cs*o° <br />Stockton, California Lodi, California Manteca, California Tracy, o°��,om <br />ES -9-2M x°.is°J vvu|oo ~ <br />- <br />