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. . <br /> APPLICATION FOR SANITATION PERMIT ' Pannit,.=~� <br /> w[ � <br /> (Complete in Duplicate) <br /> Date <br /> fo"rApplic, ion is hereby � <br /> made to the SanThis application is made in compliance with Coun 0 r cl <br /> �� . <br /> JOB ADDRESS AND LOCATION_ ------ <br /> Owner's Name---------------- ---------- <br /> ------------------------------------ -------------------- ---- <br /> i' <br /> Phone <br /> -------------------------------------'---- ^________._-___________. � <br /> Conhocho/s Numa__.-- _-----_-----__.---__----_--_--- Phone._-.___-_---' ` <br /> Installation will serve: Residence House E] Commercial E] Trailer C�� � Motel � Other E] <br /> ' / �� � / -� \ \V__0----------------- <br /> WaferNumber o� living units: -/.-- Num�o, of6o�mvmu �*". Number c� 6o+�s .,-- Lot ,�n _-�p-�%.-'3��-~'^^-~~---.---' <br /> VVa+er Swpply; Public system E] Community system 0 Private V/oharTnble -'- ft ^ <br /> Character of soil to a depth 6f 3 feet: Sand E] Gravel 0 Sandy Loam E] Clay Loam E] Clay Ej Aclobe���dpan E] <br /> Previous Application Made: Yes F-1 No EQ JeW-Construction: Yes E],�[:] <br /> TYPE OF INSTALLATIOWAND SPECIFICATIONS: <br /> (No septic tank or ces:pool permitted if public sewj�r is yailable within 200 feet.) <br /> S195�lc Tank: rest wellr� \"`_____DNtance from found.Qtion____1_0---144__-MateriaI___A_11-L��-------- <br /> isposal Field: Distance from nearest <br />. Number of lines-- ~�-~' . ` <br /> th <br /> � _«-------- <br /> Privy: Distance from nearest well ''--'''-'''--''-'''''Distance from nearest building----------------------------------------- <br /> �� Distance �o nearest |�� |ina__�����������-��---_-._----_---'-_--_-_'_-_.—_-�__��--- <br /> Remodeling and/or nepo�ring'�(describe;:---'--'---.__.----'_--__-___-__-__-----.__.__^_.. ' - <br /> ''----'--'-----''--'----------------------------------'--------'------'--------------'- <br /> . <br /> _'''---__.--_.-__.-__--'''--------_-__--'__.''-_''___----__--_-'___----__'.___-_---.__'--_- <br /> --''-----'--''-''---r----''''---------''-----'----'------'-----------------'-----'- <br /> | have that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and ru|oo and regulations of the San Joaquin Local Health District. <br /> 0-' <br /> ----_--_-------------.--'_--.-'_---.-(Owner and/or <br /> � <br /> B | <br /> x'__`'-_'__-_____-____'-__-'_--_-._._.___--'-_�_ -._-'_-_-__-_-_--- <br /> (Plot plan, showing size of lot,'locaflon of system in relation to wells, building,, etc., can be placed on reverse side). <br /> ` <br /> FOR DEPARTMENT USE ONLY <br /> REVIEWEDBY------------------------------------------------------------- ------------------------- ---------------------------------- DATE-----------------------�)� <br /> Alterationsand/or .~^~...~~~~.~.~ -------------------------------------------------------------------------------------------------------------------------------------------------------------- i <br /> ^ ` <br /> ___'--------''-'''--.'''_---''�_-'''�-'''''---'--'---'---''-'''-__--_---''''-__--- ---------------------------- <br /> ' <br /> -------------------__._-_._--_-_._-_---_-__--.----_--.__-___------_-_-_--__-__._-___ <br /> _--_--_--'-_'-_--~---'�--'-�'--''---''---''''_-'---_-''''--''''''''''''-'--_.'''_�.'-_-''__'-_-_ <br /> �------------------------------------------'----------------------'----------------_-----------------'------- ---------------------'��- ---------------------------------------------------------'------------------ <br /> . . <br /> RN/\L INSPECTION BY:---L_A/-------------------------------------------- .�����________._____ <br /> SAN JOAQ0NLOCAL HEALTH D|STR|^~/ ' <br /> /oo s""m American Street 300 West Oak Sfreet |ao Sycamore Streeuw North "C" Street <br /> $""kf" . California " Lodi. o"�"�/a Manteca, California ' Tracy, California' � <br /> 8-9-2w 8-5/ n"vim6 vv-2Wo ^ <br />