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� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> inDuplicate) <br /> Date Issued �/6ores -- -- <br /> described.is hereby made to the San Joaquin Local Health District for a permit to construct and install fhe�r/Ltrein <br /> This application is made in compliance with County Ordinance No. 549- <br /> JOB ADDRESS AND LOCATION--- <br /> Address------------------------------------ /--- - - -- ------------ -----F_Y'0_�_A -------------...... <br /> Contractor's Name .._____________.______ _____.__ <br /> Installation will owrvo; Ko:i6onco Fl <br /> PO Apartment House Commercial [] Trailer (�nu� [] o {} <br /> W �o| [� tker <br /> ` r ' *, <br /> Number of living units. J---- Number of bedrooms Z... Number of baths ��.. Lot size ��.�� --------------------- <br /> Water Supply: Public system El Community syst 0 Private JZ Depth to Wafer Table <br /> Character of soil toa �� �3 �� �wJ0 �� Clay Clay � Adobe E] Hardpan [:1 ' <br /> P |o y Application ��m6 Y C] N O�� N C � c+|o Y 0p7' No [� FHA/VA Yes [] No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septlic tank or�cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest we4 ?4�..........Distanqe from fonaafion,/4-0-----------Material--- ---------- <br /> D;sposal Field: D;stAce from nearest well-?a--- Distance from foundation / 7 Distance to nearest lot line <br /> Seepage Pit: Distance to nearest well_-------------------Distance from foundation-------------------Distance to nearest lot line----------------- <br /> Rpmo6e|ing and/or repairing (6osc,|6o):-------------------------------------------------------- - ----------------------------------------------------------------------------------------- <br /> -----------------------------------------------_---------_'-----.----.------_.-----.--_--_------ -------------------------------------------------- -- <br /> --'-----'----'----'-----''-------'---'-'---'---''--------'----'----------'----'' <br /> --------- <br /> I hereby certify that <br /> . <br /> | he,e prepared this application and thatthe work will 6edone inaccordance with San Joaquin County Y� <br /> ordinances, State laws, and rules and regulations vfthe San Joaquin Local Health District. K_ <br /> 4^Z,40_ <br /> '�� �^� �- <br /> (Signo6)---�^��.�^.�r��.^---7~. --------------.----------------]Ownn, and/or Contractor) ` <br /> By:--------------------------------------------------------------- ------- - ---------- ------ ---------------------------------------R7fml---------------------------------------------- -----' <br /> (P1qt plan, showing size of lot. location of system in relation to wells, 6uUdhmQo, n+c, can be placed on rmvama side). <br /> ---- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------- -------------------------------------- DATE--.---------------_-- <br /> Alte,w+i*nsmnJ/orracmmnmnn6atinno:-----------------_-.--_------.---_-----.---.-----.-----_----' <br /> .---.---_-----._-._--._-------------.___--_-.-----'_-.---_._---_-___--.__. <br /> --'---_'-'--''-'-'-_-''-_'''-_''''-'-_-''-_-''-_--''--''-__''--'-''---''__''_'''-''-'------ ^ <br /> �---__�����___---_----------------__-------- ____---------_---_---_-----__-------___-------___-----__�_��_____--____---__-------_-------_����������_' <br /> ---__---_-------------__������ ---- -_____---___---__-------_---_-----__---------_-------___---_____-----___---_---_�_����_ -­-------�� ---- -------__------_-- <br /> �N/\L |N�PECTON BY: -6�..��==-------. Du+a--.�������.���-��.��-----_---_.- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South America^ s+reef 300 West Oak Sfroet /32 Sycamore Street nwmor+h "C" Street <br /> e""kt"". California Lodi, California Manteca, California Tracy, California <br /> ES 9-2M ,",*edo''n,,pCo. <br />