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/ <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />Application is 6e�na6v mo6o to the San Joaquin Local <br />' Health '- 6ct6r u permit tn� construct and install the wnr herein described.This applica1on is made incompliance with County {r&nance No. 549. <br />, <br />AST <br />IDA 5 <br />JOB ADDRESS AND LOCATION ----- <br />Owner's Name--- <br />' Contmc+urs Nome --- --------------------- <br />-'-_/_, <br />__.__._. Phone----- -- <br />---' <br />ln�aUaGon*;U,e,ve: Residence K Apartment House 0 Commercial [ Trailer Co_u� 0 Mofn| ]+6or 0 <br />-Number of living units: Fj Number of bedrooms Number of baths h Lot size ------------------------ <br />Wafer <br />-----.__Water Supply: Public system [] Community system E] Private <br />C|oyLoam [] ClayE] Ado6erQ HardpanF] <br />Charo�er'of soil +ua depth of 3 feet: Sund[� �,�ve|�� 3vn�yLonmL] <br />' <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />' <br />\ r/ 0 feet.) <br />^Nm aonHc fankorcesspool permitted if public sewer is available within 20 <br />' io. .�_- <br />--- <br />� <br />| Sp i Tank: Distance from nearest well f foundation ----- k� <br />No.ofnzmp��me�+�''-��____.Cnpuc{+y_--—�_ ���v.'Uqui66npH` 4`o—�-x mL-''-----''-'_- <br />''on Distance from nearestwnL�-_--�-D&tuncefrom fou n6a�on�-_'''�--Lining � Size: Diameter -------------------------------------- -_'___.'�''-_ <br />.�''''-_.-'—_ <br />._|�ann: from nearest <br />6ui|dimg----------------------------------------- <br />;'Privy-. <br />---�'-'''---'''-- <br />/ �'�y� Distance ��m nearest well <br />EDis��ootonvore, ��||ne'''-_--__.--__-_- . | | <br />rest ----------------- <br />Seepage <br />'— <br />" 3uupoge ��� Distance to.no*no�°�|-_-.'',_-D��ncu ����n6 +�n���m��no.u�-� <br />N�o� p�� Lining material Size: Diome+ec__-__-.�_-Depth--------------------------------- <br />Fl <br />.__ <br />� <br />D I—Field:— Distance from nearest well --24 -------- Di�tancb fro _� ___ --DistanC <br />Type of filter material --- --- �Depth of filter ------------ <br />---------------------------------------- <br />' __-_----''''—''-�- <br />certi <br />/ ---'---'-'---'------------'----- and f�mffh e wmr wU done in accordance with San Joaquin County <br />_ <br />\ ` .""~~�^�.., -- .'- - � <br />' �,u�a ur*r� mex , <br />./ <br />| ` <br />� <br />) _.____,__-_^____._____________-|���-_''_----''--''--'-------- <br />' K�*+ '�-'���----��size of lot, location ��y�o�1�,e�Gmnt��eL� �ef�'mu�6efUn6w�hH�nappUcat�n� <br />\ <br />�«°or <br />DATE ' ��,`_='S�� <br />___`._____ <br />--------------- <br />APPLICATION ACCEPTED BY--''�- --'''-�''' <br />REV|EVED BY '-------'---^-''f--`-----'--------- <br />_- DATE''.`_-'�--''-'----'------' <br />BU|LD|NG PERMIT ISSUED ----------------------------------------------------------------- DATE .'-'''--�--''-'----- <br />�-�`- <br />-�'-''' <br />__________________-_- -'-_ ''_-'''� /,''-�-_.'-,'- <br />---.__-_-_-'-_-----__-_--__------_ <br />---'~-'---------'--'-''- -------------------------- <br />Date <br />—.—_._'.- <br />PERM|T No ------ ISSUED _''''` (Date) FINAL INSPECTION <br />Dot"--.__--.--------'----- y'--'�"-»---.______ <br />SANJOAQUiNLOCALHEAOHDISTRICT <br />| |3pSouth AmedtanStreet <br />� ��oukt�o' California <br />^ <br />* <br />� ss-�-2wv�o,�~|�9 <br />` ` ...° <br />