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APPLICATION FOR SANITATION PERMIT Permit No- - <br /> k-o-mole+e in Duplicate) Date Issued , ---. -- °/c <br /> t ' <br /> �- �| is hereby u6 to the So J | Lo�m| H�n|H, Dist construct+for o permit to construct and 'install the work herein described. <br /> AppThis"application is made in compliance with County Ordinance No. 549. <br /> --- A-- -S <br /> ------------- <br /> Contractor's Name--------- ___-___.____________ .,".~~___._~_._�_.__. <br /> -------------- <br /> Installation will serve; Residence ApartmentHouse E] Commercial [] Trailer Court Other El <br /> Number ofliving units: / Numberof bedrooms Number of baths /- Lot.size ��..�----- <br /> �� --------------------------- <br /> ' <br /> Water Supply; Pu6|ic system '�{ommunity system Ej private Ll Depth fo'W6fbrTable .Y-aft. <br /> (�«��� � s� � m6�� � � ' �� G�� � �n� �m � OoyL�� � <br /> Clay El /���p� Hu�� � <br /> . � ~�- _-~~� / <br /> Previous ApplicationMade: Yes E] No �� New Con�mc�un: �Ye [� Nu �� � <br /> � <br /> � <br /> TYPE Of INSTALLATION AND SPECIFICATIONS- <br /> (No <br /> tank or cessp `ol <br /> if public sewer bavailable within 200 feet.) <br /> `~esspooc D'^'""`e from ^``'`~' ''-------------------- - | <br /> [1 Size: Diameter----------------------------- Depth-----_--------._---Bqui6 CopocHy._----__'goo. <br /> Privy:. D�st nce from nearest well-------------------------------------------------Distance from nnurad building----------------------------------------- <br /> 0 Distance to nearest lot | ne-------------r---------- ------------ ------------------------- ----------------------------------------- ----------------------------- <br /> Remodeling <br /> ___.-- _. _'_Re . ing and/or repairing (deszibe):------------------------------------------------------------------------------------ ------------------------------------------------------------------ <br /> -----------------------------------------------_--_--'-__---._-_---_-__--_------__-.--._----.__.--.-.-_--. <br /> ._--._--_-_-_-_..__---.._-._____--_____.._--___.--___----.___-_--__.-_--.. <br />. her certi '-----.'__.--__'-_-'----.'''--__.'-_-'__'-_--_�_--'''_-''___'''-'_----�--- <br /> �---------' n6 fheffhm �n, �N 6e done in accordance with San Jueo�n County <br /> fy +6af \ have �n, <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location ;f system in relation to wells, 6uildingst etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> iv ----------------- DATE------------------------------------------------------------ <br /> � ---------------------- <br /> BUILDING PERMIT ISSUED------------------------ <br /> Altnrationuan6/or recommendations:------------------------------ <br /> ` -_-__. _-''--'''_-'--'''--_'-�---'''-'''-''''------'''--'---'--_.'''-'--__-'---_.____--_. <br /> -._-_--._--___._------- ----------------------- ------------------------------------------------------------- ------------- ------------------------ -------------- <br /> --'`''------'''''-''-'-'''---''--''_'--'''--''-_'''-_''-''---''----'''-''-_.''-_'''-----_-'--- <br /> -'--'' --''''--''-''- -----------------�...-'.---J-------------------'--------- ---------------------- ~ --------- --------------------------------------------------------- <br /> D <br /> L'~� ^ o+v <br /> FINAL INSPECTION BY�-,=�-����''-_�'--'-''-'''-' --'-''-'''-'-'-''-''-'-'-�--'-'' <br /> SANJ3AQU|NLOCALHEALTHCUSTRCT <br /> � <br /> � � �� ��" s� � �� �k �� |� ��� S� o|ww� � e� <br /> / <br /> $*=kto". California Lodi, California '~ Manteca, California Tracy, California <br /> ~.� <br /> _ ` - ES-9-2M � n".�"J vv�/no . <br />