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FOROFF0 use! ii <br /> ------------ --------------- <br /> - -- ------------- <br /> APPLICATION FOR SANITATION PERMIT PON# N& <br /> (CUMP1446 to Oup <br /> j De't lead <br /> ---------- . i <br /> A <br /> :,111a418fi If h8faby ffi4 §A <br /> sde 406 fi josquiti Leesf HpAh Difffid,faf a pefffiff to wiffurst aid M-aff Ae wafk k#Wrt dwAb@d, <br /> T <br /> it w1le0l'ah 10 rned's IR eampAstwo is own4y 6fdIffarlee No, 90, <br /> JOB ADOW AND <br /> ---------- <br /> . ................................ -----------­.... <br /> ............752'0 St.'; Lathrop <br /> ......... ------- <br /> ................................................. <br /> 982-1079 <br /> ---------------------------------------------------------------------- <br /> Walw6ii 4 i6xi. Raida" 15 APOR0 14fte 0 CaffiffiefiJai f ffbilef 66uff 0 W61 12 OOW 13 <br /> mumbaf d hViRg uRi4i fit mb&af NUM166f d WAY z' L&fi�@ ..... -------- ....... <br /> ................... <br /> W&F kp* pubk Waffi d8ffiffiu* Fl§t6ffi 13 -NiV06 0 960 fe W&W T&W <br /> 00866F 6f 18if J8 8 460k,&f, #W- .§and d-6-f6of 0 9-ody Loam @9 Qsy Lssow(3 96y 0, Add(W 0 H&FdW 0 <br /> FfaAsui Appkeiafi Mi6i (it Val He New.§&ufraS#M s 1YG§ M W FHA/VA-"Yet M. NO 0 <br /> ffff Of fN§fALUf1@N ANO §FWPft;A%t1@ <br /> (Na woie 4ak 6F wwulf Ad W.1 <br /> 001 <br /> §BpfiE f8fik... 94SR66 feeffi msfaf A <br /> Hai. 6f e6ffiPe'r4 ------.......... al <br /> 4.......­11....... F§t&ff_@ id Nam k&;� <br /> --------- ----L@64A, of gadh 6f ffmeh;...........24.11.,_� ...... <br /> ............... <br /> Type of filter material.,------ ...Depth of filter fiiaterial2._?4------ ----fotaf length-_1-------_-....4 ------------ <br /> Seepage Pit: Distance to nearesf-well----------------------Distance from foundation....................Distance to nearest lot line.___..._.._....._ <br /> ❑ Number of:pits.................... Lining material............._._ <br /> ----...Size: Diameter.......................Depth................................. <br /> Cesspool: Distance fiom nearest weW-..,.-_---------Distance from foundation.-...................Lining material..................................... <br /> ❑ Size: Diameter----------------------------------- Depth'. _.L...Liquid Capacity-----------_---------------gals. <br /> ---------------------------------------- <br /> Privy: Di"stance from nearest well____..-........ ................ Distance from nearest building------------------------------------------- <br /> riDistance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodefin and/or r� irin? (describe):-----------!Temporary sewage facilities un tilisewage disposal <br /> ---------J_ ...............­......... ......................--------------------------............................................. <br /> I g . r <br /> .............p...ant i ns alled in subdivision, montth <br /> .............................. <br /> approximate time of installation 4 <br /> --------- ------------------I.....................installation......­........ <br /> ----------------------------------- <br /> F j <br /> ...............................................................................................................-------------------------------- <br /> -----------------------------------------------------------­------ <br /> ............................ - <br /> ----------------- .................................. --------------------- ------------------------------------------------------------------------*-------------­-------*------------- <br /> I hereby certify that I have prepared this application and that the work will be donelin accordance with San Joaquin County <br /> regulations ordinances, State lawi, and rules an re 9-lation of fki San Joaquin Local Health District. <br /> (Signed).......... ......------------------------------- ...(Owner and/or Contractor) <br /> BY . <br /> ..;v". -.*"* ----**--------------------------------------------------------------------------------------------(rifle)----------6� -- ------- -- ------------- <br /> (Plot plan, showing sire lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DnRTMENT USE ONLY <br /> APPLICATION.ACCEPTED By'. <br /> -------------7-------------------------------------------------------------DATF__ ---------------------------------- <br /> REVIEWEDBY.............. ------------------------------------------- ---------------------------------------------------.... DATE--------...-------•3.......... ----_-----------_------------------- <br /> BUILDINGPERMIT IS,S U ED_._;'..­...................................................--------------------------------------- DATE.................._A..........._------------------------ <br /> Alterations and/or ......... ...................................... <br /> ............................................... ---------------- ................................................................................................ <br /> ...............................................................................:.............................................................................................------­-­-­ ................. <br /> ........................I——---------------------------------- ...... .......­­----------I---------­­­.............................................. .............................................. <br /> ...........................................­............ ------------------------------------------------------------------------------------------------------------------------------------ ------------------­ ...... <br /> FINAL INSPECTION ------- ------------- Date--------------_- ------ --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I - <br /> ISO South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,Callfornic Tracy,California <br /> EN 9 RCYISED B-59 2M fl-CZ ATLAS <br />