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� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> / ~ ' ' � . <br /> � � y 6 � t� Sa Joaquin �� H�|� D�6df� permit to n6install the��vorkhnd described. <br /> u <br /> This application is made / m County Ordinance No. 549 ' <br /> JOB ADDRESS AND LOCATION,4W- ----- <br /> Owner's Name----------------------------ealroo - <br /> Confrac't&'s Name_____._0;_ ------ -- -1 ------ -- -- --- ---- -- Phone_ <br /> Installation will Kesid [] Apartment H E] Commercial railer Court W ` <br /> Number_ --' <br /> - --� - ' of --_ -------- <br /> _- _'-_ - - ---------------- --7.37; <br /> _- -- '-- . <br /> _-' -_------------------------------- <br /> �� <br /> W� Supply: Public system ���mmun�.s�m -E] Private � � �� � � <br /> �Du � r6|��.-ff. � <br /> Character of soil to adeo+h of 3 feet, Sand <br /> d* H� dpan []� [ { [ <br /> � Yo� ~ qP,e"|ous �ado: Yes [ No ,50 �"-ewConsf,uc�on � E] <br /> � <br /> ' <br /> TYPE {JFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted �if public sewer is available within 200 feet.) � <br /> Septic Tank: Distance from nearest well----------------- from foundation--------------------Material ---/-.----.---_.--.-- <br /> of ` <br /> i <br /> Disposal Fiel : ^ Distance from � AV <br /> L��~- m �er ,f | �m�r� � <br /> Type of'filter <br /> 00 <br /> Distance � ' -/ Dto nearest lot line-10� � <br /> �w | <br /> -Aelo" Number ofpits---j1J44-*�'-Lining muh:ria| Size: Diameter-���.---Dup1�- �__--- ' <br /> ' ~~ ` - <br /> from nearest well ^ � <br /> , . <br /> Size: Diameter <br />- ' - - <br /> Privy: Distance from nearest w�|'''-_'''-� T- <br /> ------- <br /> ----- <br /> �� ---�'Di�unon from~n�n'o.7s�6v�cc"._y�'--°----°-'-'-_=- <br /> Remodeling and/or repairing (describel---------------- - ------ .. ............ I.-i- ------------------------ <br /> . . <br /> / no' . <br /> ordinances, State laws, andirules and ul'ti6ns of fhe,,$an Joaquin Local 11jeailth District. <br /> ^ <br /> my x- � <br /> , <br /> /�� :�n ���g �� of lot, ���� ��m � ��� � wells, ���g� e� c� �e p�� '� ��� 66e� <br /> ` plan, � . . ^ ° / <br /> FOR DEPARTMENT USE ONLY <br /> ' l � <br /> APPLICATION ACCEPTED 8Y.--',^'''------' -'--__-_.-­'--_'''- DATEL. <br /> REVIEWED 8Y_-.--~_---_--.--_---__-----_-_-.---__-.-'-__. DATE� ' <br /> . " <br /> BUILDING PERMIT BSUB]'--''_-.---_--__.''-_---_--'-'-__'''-'''---' ------------------------------------------------- <br /> Alterations <br /> '-----L-'_-'''-'_'__ _ <br /> A�nr �ons�and/or 6wHon�'-��''�-''''--�'''-''--_.''-__---__--''_-��__.-__''---'-_�____.__._ <br /> . ' <br /> —`--`--`--`'`--`---`---``---```--```-``````--```---```--`````-`````---``--'``--'`--'----`--'---' <br /> ` <br /> ---'---_.'_-'-'--�__'---''-__-�''---'---''''----''--.-'-'---''-_.''''-_.-''_-.--__---_'_____-__- . <br /> .___._--__-_.-�-` '_-__! ._-_-._--.----._-._-_---_---.--'._''''-_-______________._ | <br /> / ' <br /> _--'--_^--_-''-'''-'--'----'''-''''----''_-'''--''-'--'-----''---'''_-'-''-_-.'''-_.'�--.-'-'-__- <br /> RNAL INSPECTION BY*----------- ''�-' Dot�'�' '--.'---'--'-____. / <br /> ^ ' ' <br /> ' SAJ4 JOAQU|N LOCAL HEALTH DISTRICT <br /> |w South American Street avnWest Oak s+r°w /nz svc°m"= Street o/+ North ^c^ Street <br /> Stockton. California Lodi, California Manteca, California rmo» California <br /> ` <br /> *SL-9-2w B-5/ Revised w-2/00 <br /> , \ <br />