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� <br /> !! � APPLICATION FOR SANITATION PERMyT <br /> � r=,m/r <br /> (Complete in Duplicate) <br /> Date |/o/Issued/vau`� <br /> pficafion <br /> nis hereby made fothe onJnuq�n Local Health D|��cf �ru porm� focon�mofand install the work herein �eacn�ad-'/ application /� m�de in compliance with County O,6/nonm, No. 549. . <br /> � <br /> ------------------ ------ <br /> . V� ----_ --�-_~ <br /> / Contractor's Name_------------------------ � — ` <br /> ________^~~~.~�`_____-_.''''__-''-_'-_'--_'--'-'-''' Phono- <br /> |nstaUu+ion will serve: Residence x Apartment House [] Commercial [j Trailer Court F] Motel [] '---'-----'- <br />� Number of living units: / Number [ bedrooms <br /> / Number / L -��- <br /> � -~- um o, u o room� -'-. um �, of 6of6� .+-' �+ size --..+.����.,`.�' <br />^ YYufar Supply: Public system Ej Community system 'El P6vofo <br />� � Depth to Wafer Table -------- ft <br /> Character � �� � a6�� mf� �� ��J Sandy Loam E] C| L� � C�r � Adobe <br /> ardpan <br /> Previous Application Made: Yes b--No New Construction: Ye S No E] <br /> TYPE OF <br /> INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available"within 200'fiet <br /> Septic Tank: Distance from nearest well__-7Q'U__Kpis-fffandcte)from foundation-----A0-------M a tte - i <br /> ' ------- <br /> Disposal - `--~- <br /> . .~.r.ye . .. muuncn to nearest well- Distance from foundation <br /> twcr <br /> Privy: Distance from neareW�iell---- ----- -----9 <br /> Remodeling and/or repairing (describe) <br /> I hereby certify that I have prep�red this application and that-_the-_wor-k-_will-_6-e-_d-o-ne-_in-_accord-a-nee-_with-_San-_J-oa-quin---C-o-u-nt-y- <br /> ordinances, State laws, and rules andilregulations of the San Joaquin Local Health District. <br /> -,.-------------------------------- <br /> .__._____-_--------__--__~�^. .._-, '� � <br /> Up�f o�» showing size of lot, location of ' --- ~----~~~�--------------- � <br /> uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE <br /> "c./Ewcu BY <br /> �---- --- <br /> -------------------------------- <br /> Alterations and/or recommend afions: <br /> ------------------------- <br /> ------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C', Street. <br /> Stockton, California Lodi, Cal'rfe>rnia Manteca, California Tracy, California <br /> sx-9- wB-5| nv.u*d vv-21on � <br />