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' + <br /> APPLICATION FOR SANITATION Permit No. <br /> ^ � �7 <br /> ' ' ' ' Date Issued - <br /> �L. <br />� is hereby made to the ' Health <br /> This application is made in compliaiic'e with County Ordioapme Nce49, _4 <br /> JOB ADDRESS AT L <br /> aOC IT I ........ ---------------- ------ -- -------- ------------------------------------------------------------------------------------------------------- <br /> Addres <br /> Contractor's Name___f,_-e--------------------- -------------------------------------------------------------------- ---------------------- Phone----------------------------------- <br /> Installation will serve: Residence Er-"'Apartment House E] Commercial E] Trailer Court E] Motel E] Ofhyr <br /> Number of living units: ---/--- Number of bedrooms ---1--- Number of baths __1---- Lot size - . 0� <br /> Wafer Supply: Public system E3 Community system [-] Private [Rr/Depfh to Wafer Table --------- ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam El Clay Loam E] Clay E] Adobe El-lHardpan E] <br /> Previous Application Made. Yes E] i No V New Construction: Yes 2/No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cessp'pol permitted if public <br /> ,1 1 ewer is available within 200 feet.) <br /> ---------Distance from foundation--- Distance to nearest lot li <br /> Dis I Field: Distance from nearest w �1__ /0 <br /> Cesovo : Distance from nearest woL-'---Oistuncofnzmfoundufion- - ----------------Lining material '-'-�__________ ~ <br /> [] Size: Diameter---- ---------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy. Distance from nearest well-------------------------------------- .......... from nearest6vi��ng�--'-______.____ | <br /> [] Di�oncetonearest lot |in�------------_.����.��--------------- _______._______________.__.� | <br /> ` <br /> Remodeling and/or repairing (demzibe):--'--'''—-------------------------------------------------------------------------------------------------------------- \ <br /> ---.___'-..__..__.-----.-'--__-__--.—_-____.-__'-_--__---..`�-----_-_-_—___. <br /> ------------- ----___---_------------_-------___---__------'_-----� ���_��'�������__��_��'�������-���__��'��_��'����'���' <br /> . . <br /> -------------------------------------------------' ..............'----------------------------------------------------------------------------------------------------------------------------------------- ---- ''-' <br /> | hereby certify that I have prepared this application and that the pork will be done in accordance with San Joaquin �� <br /> � � <br /> o,� �fat� of San Joaquin Health �� 6mt^ ' ' ' ' <br /> ` ' - k � <br /> (Sig ----'---- -----------------------------------------------'------------ -- and/or Contractor) <br /> . . <br /> By:------------------------------------------------------------------------ ---------------------------------------------------------.[[itle)--------------------------------------------- _____. � <br /> /Plot plan, showing size of lot, location of system in relation to ~6lis, buildings, etc.. can be pla� � �� �� <br /> . ` <br /> � <br /> FOR ~. ',.~,~~,. USE ONLY <br /> '= <br /> Alterations and/or recommenda+io --- ----- <br /> ------------------------ <br /> -''-'-- / <br /> � ��---------' ^- <br /> '------'-----------------''�1-----------'~---'—'t�'-'---------- -------------------------------- <br /> —''-- --------------------------------------------------------------- '''=-------------------- ----------------------------------------------------------------------------------------------------------------- <br /> / <br /> —'-''-'--.-_-'-''-''_'''--'''----''_- -------- ' -------------------------------------------------------------------------------------------------------------- <br /> ` <br /> ' <br /> FINAL INSPECTION BY:---'''—±''-'''-''_-'-''''-' Date... — - ---- <br /> SAN <br /> --SAN JOAQU}N LOCAL HEALTH DISTRICT <br /> / <br /> /30 South American Street 300 West Oak Street /32 Sycamore Street aw north "C" Street <br /> � <br /> Stockton, California Lodi, California Manteca, California ?mov o"Ufomia <br />