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FOKOFF <br /> ' '-r~- <br /> - - <br /> -« APPLICATION FOR SANITATION PERMIT Perinit No. <br /> (Complete ' ' Date Issued <br /> Applica4ion is hereby made.+o the San Joaquin Lo' cal-He'alfh Disfrictfor a permit to constructand insta 11 the work herein described. <br /> This application is made in compliance %�ith County O� rdd' nice No. 549. <br /> JOB ADDRESS AND LOCATION.1m Jo....... <br /> __ __j --"I_-j_'� : ------ ------:---------------------------------------------------------------.- Phone/�-. <br /> Installa-tion will serve: Residence W Apartment House 0 Commercial E] Trailer Cou:rt Motel '[] Other <br /> Number of living uni;8� -Number of bedrooms -1--- Number of baths ---I....'Lot size ------------------ <br /> Water Supply: Public system U�_�om_munity system F <br /> ]- Private [] Depth to Water Table _�Vf_t <br /> Character of soil to a depth of 3 feet: Sand L] Gravel E] Sandy Loam [] Clay Loam El Clay Adobe Ug"Hardpan C] <br /> Previo�.s Application Made: (If yes,date.... ----------) No EP" New Construction: Yes [a-No E] PHA/VA: Yes [] No R9,� <br /> TYPE PF INSTALLATION AND SPEdIFICATIONS) <br /> (No Septic tank or cesspool permitted if public se,�Ner)s available within 200feet.) <br /> Septic Tank: Distance-fro' m -nearest w,'11--?W:.�'-(-----Distance'frorg foundafion---,-44-------------Material------ <br /> D;sposal Field: Distance fror�'nearesf weli-,Izcr,�e--..-Distance'-fFo—r;-foundaTlon../%?,--?�- ��--Distance �6 nearest lot line__J::�-------- <br /> Jr <br /> Seepage Pit: Disfance to nearest-.well--lhzxt--------Distance from f-oundatibn/-d,��...�-..Disfance.'to,nearest lot line__�.�_ ........ <br /> El Size: Diameter_ <br /> Distance to <br /> ----------------------------------------- <br /> Romo�el6/u Yda, -----------------------------------------------------------------------� <br /> ' —'-_.-_.-''-'--.' <br /> ----------------------------------------------- <br /> ' '~'~~' certify^ that ' have p .� <br /> ordinances, State laws, and rules and <br /> . District..,.,-' *^ �^ <br /> r�'~~ ------------- ----------------- <br /> Bu __--_ <br /> (Plot— plan,— showing --~ of '-'' ~~~^~' of ^r'~^' in relation to wells," "°="�� = be placed on ,e°=,m» side). ' <br /> ' ' <br /> FOR DEPARTMENT USE ONLY ' <br /> ------------------ <br /> REVIEWED BY------------------------------------------------------- . <br /> 8U|LD|NG PERMIT ISSUED---------------------------------------------------- <br /> ------------ D/gE_-.----_------- -------------- <br /> .___AAlterations and/or <br /> KmruNonsand/o, :-------------------------------- _----'___`'__.._______._________..__.._._________. <br /> ._-'-'' -------------- <br /> 21 <br /> ' <br /> .�- ' ----'''--''' / <br /> x�x/, �� � ' .^-- ---'--r--"--�, --'---~�'---~-- "`s-~°� ' <br /> --=^ ^-w^..L��=rf-L-�-'`��.L7-.'--2-------------- <br /> -------------------------------- -----''_-.''--'�--_-'''-'-'''---'--'''-''--''--''''--..-''-'-_ <br /> ~ '--''-''_-- . <br /> / . <br /> ' �/- <br /> RNAL |NSPE{�T :�'��7-��' Date--------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> —' ---'SANJOAQU|NLOCALHEALTHD|STRICT r <br /> /30 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Locil,California Manteca,California Tracy,California <br /> "".""",."""°."°,.,=D."" "."" ` <br /> [ <br />