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i PIGE <br /> FOR OFFICE 6 <br /> Permit No. <br /> :APPLICATION FOR SANITATION PERMIT <br /> ---------- ----------—----------------------------- This Permit Exl2ires I Year From Date Issued Date Issued .....�// <br /> Application is hereby made to, the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> This application is made in complianc�_ with Coun Ordingrice No. 549 <br /> JOB ADDRESS AND�LOZA&01N...3Z � __2 nt"o .,Vgu. -�................................................9.. .. ................/....... <br /> Contractor's Name-------*.. ........... ------------------------------------------------------------------------- Ph4 - ----- ----- -------- <br /> Installation will serve: Residence E3,-_A'partment House 0 Commercial [] Trailer Court [I Motel [] Other [I <br /> ----------------- <br /> Number of living units: ./--- Number of bedrooms Number of baths ---Z_ Lot size ------- <br /> Water Supply: Public system ��Clmrnunity system [I Private [3 Depth to Water Table,"/ <br /> Character of sail to a depth of 3 feet: Sand Gravel C-] Sandy Loam 0 Clay Loam F1 Clay 0 Adobe,M-1;ardpan 0 <br /> Previous Application Made: (if yes,J'ate--------------------) No El New Construction: Yes E] No 0,-fHA/VA-. Yes [3 No [3 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> os ield: Distance from nearest well---L-------------Distance from foundation-------------------Distance to nearest lot line................. <br /> Seepage Pit: Distan-6e to nearest w 11 Distance-f-rp�p fou dation__,�R., <br /> llntiiireby ce that I h'ave pre�ared this application and that the work will be done in accordance with San Joaquin County <br /> St <br /> S4 <br /> ordim ce e ws, and 'rules andre I tions of the San Joaquin Local Health District. <br /> ",A;aT, <br /> (Sioned).... .. -------------:------- . . ......... A-A <br /> :----------------------------------------------------- - -::_)� <br /> (Plot plan, showing size of lot, locati�n of system in relatioh to S, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> Alterations --' <br /> and/or ~ ��)----'^'^~`'^--~ ^'~ ~~-~~ ~^-- ' --'�7'~-----'-- ---- --'-----'_-'��/ ,--.--_''--' -''�`-_-----'---_''-_-,''�'''_-.'^---'-_-''-''`_--'' -_.--'--- <br /> .-__-- ---'------_-.�._._-_---._-..-_--_-'---_----._---._.__-_-_--__ <br /> _______________..�_____^_�__________`'-----L_'-�----''''-------'-''----'-'-'-'-'-'--�'-'-- <br /> ' . /. �/ � <br /> RN/\L INSPECTION BY:.- ----- u��r��-..,^�~�--yc'��---_-------- <br /> / ~ ` <br /> SANQUUN0OCALHEALTMD|STR��T <br /> 300 <br /> . . <br /> 1�:���o� / ���Oakvrro*t . ` vm*Sycamore otreet 205 West 9th Street <br /> Stockton,California ' California Manteca,California Tracy,California <br /> = p ncn"r" n'v, o" "'"/ ^``°° <br />