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t \ <br /> APPLIC ATiON FOR SANITATION PERMIT Permit No. <br /> l ' <br /> (C-onmmlefo in Duokcaf* Date Issued <br /> ~ . <br /> Application is hereby made to the San Joaquin Local Heu|H` District for m permit tocon ' ct and install the work herein described. <br /> This application is made in compliance i ount r in n <br /> JOB ADDRESS AND LOCATION---- ------ - ------- ax, �_- _/--&-bl------------ ---------------------------------- <br /> Installation will serve: Residence, artment House El Commercial E] Trailer Court E] Motel 0 Other 0 <br /> --------------- <br /> Number of living units: Number of bedrooms Number of baths ---L Lot size <br /> Dept h to'Water'Ta <br /> Water Supply:. Public system Community system E] Private ble <br /> Character of roil to a depth of 3 fee+:i Sand [-] Gravel D Sandy Loam 0 Clay Loam [] Clay El Adobe Hardpan 0 <br /> Previous Application Made: Yes [:1 IN New Construction: Yes %,No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Set)tic Tank: Distance from "earesi well-_50-Distance from founda:�o�,/_0_-/-____Mat ' I------ <br /> Disposal Field: Distance from nearest well----6.0-----Distance from foundation___74�.)--------Distance to nearest lot line----- <br /> ---------- <br /> Remodeling and/or repairing (descri6o):------ ------------------------------------------------------------------------------------ -------------------------------------------------------- <br /> .._-_-----_—_---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> . <br /> ------------------------ ----------------------------------------- ---------------'---------'--------------------------------------------------------------__�_---_____--------------_-------_---_------_�----- <br /> -----------------------------------------------_---___�.__.__--_'-_.'''__-----'''-''-_.'-'''_—''''-_-'''_--''-'-''-'_-'- <br /> I hereby certify that I h ^ this applicationand th� the work will be done in accordance with San Joaquin County - <br /> ordinances, laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) --����" --------_---------'------------(3woor and/or [:nntract*t) <br /> ��________.__________._.!`_______-______._----_-------..R7 |o1-----'---_-.------------------------ <br /> (plot plan' , showing size of lot, location of system in relation to wells, 6mi|Jing", etc.. can be placed on reverse side). <br /> !. <br /> APPLICATION ACCEPTED BY. ' ���E <br /> - - - ----------------------------- DATE-.-'__—. DATE--/'�^--�^—��- �-._—.- <br /> ------------- <br /> Alterations and/or recommendations: <br /> _-'__''_''---'''-_''_-'''---'''--'''.'�---''-'-'''----'---''-_''''-''''--'-''---_-_-_''_-.__.'--'-. <br /> -------'----'--'----------------------------'--------------'--'—''-----'' <br /> --''--'----'—'''---'----''-'''-''--'''-'''--'''--'''--'''-''''—'''''''--'--'''-----'--''''—' <br /> -'''-'--'-'--'--'-,' '' ------- -''''_''--''--'''-'''--'_'''-'' ------ -------- <br /> FINAL INSPECTION BY:-'' ^^�------' --------._._-------------- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> mo South *rn"ric=" Street 300 West Oak Street mz sv=*m^= Street u/* North "C" Street <br /> . <br /> Stockton, California Lod,, California Manteca, California Tracy. California <br /> � eo-9-2w 10o2x*.uv6 vv'000 <br />