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' <br /> FOR <br /> APPLICATION" .^ `~~ SANITATION� � . PERMIT <br /> / <br />---------------- ---------A-. ------- (complete in Duplicate) Date Issued � <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOBADDRES3 <br /> Address---­-----­--07 ---- ------ 7__-----------------------------------_------ <br /> n 7 <br /> p�w�o_-te'l L� Other <br /> Installation mmr°m: Residence M"Apartment House [] Commercial [ |,ui|wr Court C1 <br /> Number of living units: .-/-- Number of bedrooms *7.. Number of baths __/_-. Lot size - ° <br /> �-J- <br /> -'.----' <br /> WaterPublicsystemX Community system [] Private [] Depth DDepthto Water Ta6le-19�. ft <br /> �hmnm��r ^ wwsoil �w � �e9t� � f��f; Son6 [] {�"x°a| [] Sondy Loum [] C|uy Lomm [] [|my [] Ado6mg Hm,6oanD <br /> Previous 'Application Mo6�m: (if yes,date--------------- -) No [] New Construction: Yo, [] NoX pHA/VA. YeuNo <br /> 7KpE OF INSTALLATION AND SPECIFICAT|ONS: , <br /> (Nom-mmptic tank *rcesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nvnro,+ well...-------------- from foundation--------------------Material -.---.................................. / <br /> No. of compartments--------------------------Size--_----.-- ---Liquid depth--------------------------Cupiidh ....................... ^ <br /> � �Db+onco from nna,00 well--------- -------DistU <br /> Distance from foun�uon----------__- <br /> Dbtuoc= to nearest loline <br /> Number of lines-----------------------------------Length of each line------------------------------Width oftrench-----------_---''---- \. <br /> ~~ � Type of filter material Depth of.filtor mo+o,u| 'Tntu| length ^ | <br /> ^~^S� ~ � c � . u � cAp Pit: Ui�onoo to noon,^t o � �, .. nearest ... .. <br /> �� <br /> 6bo� Diameter � Deot�..'.�� ..................Num6nrof pits /-_-_Uning ma+e�uL ' ./ <br /> : Distance from nearestwoL-'---Dhh�oafrom foundot�n---''----�n|ng moto��'----_---��_-- (�. <br /> �a <br /> - <br /> Size: D|omota,---_--------..Ueot _------------'_----L�u|6 Copu�ty ---'._..`.--'gab <br /> Distance from nearest well---------------------------- --------------------Distance from nearest building----------------------- <br /> ' . � Dh�mnce «onnmn,� lot line-''-''-'--__---.-_-.._-'-__'.----_----''-'_-�--_----' <br /> ' . ~ <br /> , Remodeling and/or repairing kdmscrib* :---------------------- ---------------------------------------------------------------------------------------------------------------.---------------- <br />� ---- -=_____--'--'------'---''--'-----'-------''-'----'-''--'--'�--'-'-----�--'-'-- <br /> . .................................... <br /> --.' ^ -----' <br /> _-___---._--__----__----_'--_'___..___'._-_--..__.___-.___'---''--.-___. ��,- <br /> ----------------------------------------------------------------- ------------------------------------------------------ ---------------------------------------------------------------------------------- <br /> ' . <br /> I hereby certify that I have prepared this application and that the workwlU be done in nJ with San Joaquin County <br /> o~"'""`'~=w ��laws, andI ti of the San Joaquin Local Health District. <br /> '~~ ~^~ ' <br /> in relation to wells uildings, etc., can-be placed on reverse side). <br /> (Signed) ���� *�-�-p4 <br />' �v ~- -�''-- <br /> � <br /> (Plot plan, <br /> � <br /> FOR DErAm/nxEv/ USE ONLY � <br />| <br />' ------- <br /> Alterations '.. ------------- -="=`^W..... <br /> .�. <br />� --- "C�-.__---- ----------------------------------------------------------------------------------------------------------------'---------------- <br /> ----------------------------------------------- -------'--------------''--'----'---------''-''''----'--'---- <br /> -�'-L.-'--_'''----^''-'-'--''-'''-'--'''--'''--�---'---'''—''----''--'----'---'-''----'-'- <br /> �.---�-'---''-'----'-------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ <br /> , HNAL INSPECTION 8Y�����^ '/ uu,n-^'''-_-''-'-''-''--''-'-_-'-''- <br /> f ' --'-' --------'-� <br /> 'SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> ^=' <br /> 130 South American Street 300 West Oak oiroet vovSycamore Street oo5West 9th Street <br /> Stockton,California Lodi,California Manteca,m //fo�/� r�",''c*vfO <br /> rniQ <br /> tm 9 REVISED "'"" "uw'mATLAS <br />