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� <br /> � <br /> '\ APPLICATION FOR SANITATION PERMIT PermitNo. 3 <br /> k��mo�� � C�o�*�1 <br /> ` �`� Duplicate) Dufo Issued <br /> / <br /> Application is hereby made to the San Joaquin Local Health District for u permit to construct and install the work herein 6asor6o6. � <br /> Thiso9pUcoHox-|s made in compliance with County Ordinance No 549 <br /> � <br /> Contractor's Name------- �� - <br /> --' "'' '' <br /> m�^'�~� ~ ~ <br /> ~~^~^~~~^^~~----~~' �~�-- � <br /> � ~~''~--~~----------- <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court [] Wn+o| [] Other [] <br /> Number of living u6its; ----- Number of bedroc�ms Number of 6afkx Lot xlize .�l - ~�- <br /> Water Supply; Public system Community system El Private F-­] Depth foWafer Table <br /> ��l' ft 1 <br /> Character of soil to a depth 6f 3 fowf/' Sand E] Gravel 0 Sandy Loom [] C|n Loam EClay EAd Hardpan E ' <br /> 'k <br /> 'p,ovnus App\caton ��mdo: Yos El N�w Con,troctyon� Ym, �� NoJ ` FHA/VA. Yoa E] N9/p`� /^, ' � <br /> TYPE (�F INSTALLATION AND SP��|F|���T|[>NS; <br /> (No � pu6|/comvo, |, mvm||m�|ew���n ��� f <br /> ^ _t. <br /> Distance from nearest wJ|'*-----Distance from foun6afion ASV-'--Mo+o,io| � —- <br /> --------'-- <br /> m compartments <br /> m *z mn * u u o o ' <br /> /40- -------Distance to nearest lot line-, <br /> Distance from nearest well Di'sfance from foundation--- <br /> o PiDistance p D� -'" � ' Di nron,,+ � + |� --.Sr <br /> Number ofpits-------/------------Lining mo+eriaL-_J�i����S��� Diometuc''.�L��-�.��Dup+�-� —.--- <br /> C�zo�ol: Distance from nearest well ''-_'''Distance from foundation--'---� Lining material -----------------------'-'_ <br /> ElSize: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity---------------------------- <br /> Privy: Distance from nearest well'---'---'''-'''��'— --D�stunce from nearest 6uif6ing�,��------------------ - ---- <br /> Distance to nearest |nf lire . - - ---------------------------------- <br /> Remodeling <br /> .- � <br /> . � . <br /> o6 | and/or (describe):---. � <br /> ------ --------------_ <br /> ' ---- ---r----'~�- --'-_~�-- ~----' '' <br /> ----'- -'_ --'' / ---' '-- ]�''---- -----------' <br /> ��������������-------------------'------'---------------------------------------------''------'---------------------------'-------------'-----------------------------------------------------------' <br /> I hereby certify that I <br /> 6 �� � k accordance <br /> ns <br /> ordinances, State laws, and rul s and e U T1 s 0 no Saan 4-oaqu' Local Health District. <br /> 4;9- <br /> . <br /> By: <br /> (Plot plan, showing size of lot, location of systemn in relation to well ildings, etc., can be placed on reverse side). <br /> FOR DEPARTMER-T USE ONLY <br /> APPLICATION ACCEPTED DY.----. - ----------------- ---------------------------------------- DATE-..�2�� ��-REVIEWED BY----------------------------------- ~ <br /> BUILDING PERMIT ISSUED_.__-__--_-._____'-----_—_--.. DATE.---'_.__----____-- <br /> AKe,u+ionu and/or recommendations:----------------------------------------------------------------------------------------------------------------------------- --------------------------------- <br /> ---------------------------------------- <br /> -_--�,. ==-__-.------..__---.----_-_---- <br /> ---__'-'-_ _- .__--_]�'_------_._--__._-��_-��--._.___--_-._---_�-___._- <br /> ._ ��1��q/�. ���f�. --._-------_--_-_------.—_'----- <br /> '-''-' 'J' --'-'''--'-'---''—'''--''''--''-'-''---'— <br /> �N,�L |NSPE��T ' Du+ '-���''���'-�'5_710-'''-''��'--'-''- <br /> S/4N JOV\QU|N LOCAL HEALTH DISTRICT � <br /> /so South American $,=m 300 West Oak Street /sz sp°"=re s+="+ 814 North ''C^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />