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PERMIT Permit No. .........
<br /> APPLICATION FOR SANITATION
<br /> --10
<br /> (Complete in Duplicate) Date lssue�__ -
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<br /> _T T work rein des'cribed.
<br /> F7 77.7-T FF
<br /> ,for�ape�rnit
<br /> -�J&! San fo!c6njtij0j4d I n f
<br /> Applii�a y
<br /> �7�;Vy County Ordinance 4
<br /> 18 with.
<br /> A-is-ma e in-comp iance
<br /> This 6pl3iicatio
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<br /> JOB I ADDRESS-AND'-LOCATION j :-. -t
<br /> + t Phon:e_�_ ------------------------
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<br /> Owner s"NAme— ----------4t-6 -- -----
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<br /> Add -------------- -4---- --_
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<br /> Contra't r's + Trailk Court Jo', Motel 0 Other El
<br /> Cb��ercial ❑
<br /> Instaillaiion �vill ser;4e!: -R;s",4e�cte'%,, Aparfment Flbd�e 13
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<br /> &�� -1 4 7 ++
<br /> �ur�b�er of ba4s i f IL�of-site, :__x!-------- --------------
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<br /> Number.of living NoAer of bedrooms ---------
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<br /> Community,�systerrt _F
<br /> 1 - system i�6tel❑A ep o
<br /> uppy'l _Uislid
<br /> Water
<br /> Adobe Hard an C1
<br /> J' �y-Lobm 0 day L�'amk Q Cla'Y El
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<br /> Previous r - I TS
<br /> 6F�lk�i.XLLATIOWAND 5PEC,'IFICATIO'N 200,feL
<br /> TYPE - , ' ' --
<br /> ,.septic' 4 tank o� cesspool P,,�'Arniffed 'if,�,u6lk�;ewqr is a ilabI6 withirl
<br /> f -ate's� we ------------ tio n
<br /> eriaL
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<br /> e p ic Ta n k,- -t, DistahCe: rom r ne , , , ` _-1-Capacity_---------I------
<br /> ------2 __1Liq'uid;depth';
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<br /> No 6f j cpT pa ri 4 f
<br /> 14 4-11+_ e to nearest 0 1
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<br /> istai)ce from, �_-,------'--: pis anc,
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<br /> Disp?sal'Fidld:i� are�t D
<br /> I , '6 Width of.i -------- ---------
<br /> r I . '. '1J." ) Lengfh�of each
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<br /> L r._ 1``} -..Total'4- otai' !length----- ---------------
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<br /> 'Chi of fllte ma ena
<br /> Type ol e
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<br /> Nbrhber of k6es
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<br /> istan'ce.to, nearest.16t line----
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<br /> nj earest well. �f��f(3un�;�io n
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<br /> Seep�aa�ge if:j 1. J_ I - - __ -
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<br /> rnateii6l----------
<br /> 4�-dumber t
<br /> jomaterial____ .._- ----------------- ------
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<br /> U rid6 t:
<br /> p C'e" 1-0 nearest. �4i: -_t .1. L gals.
<br /> Cesspool I i. 4 is an + i Liquid Capacity-------- " 9---------------------------L ----
<br /> ze: da e er----:-------- -----------
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<br /> Distanci�jrom, nearest building
<br /> Distance 1.rqr�,nearest . .....I------
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<br /> Priv .D t ...7t4-- - -----
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<br /> Rorn6rdelin'4
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<br /> 4 �t4 4-'
<br /> .....a-A----- 7------ t oaquin County
<br /> ----- ---F-7--------------- 1,ai:dordance with'San J
<br /> ------------------- one"in
<br /> h
<br /> d fhat'fhe-Wrk-�vili+berdi
<br /> prepared
<br /> `this hereby-Certify.-ihat-l- 'aVe--Pt f"fhb_Sad'J6aquin Local-He"ailth Districf.'
<br /> s "SW� laws,Ia`nd ruile's and "regulations 0 L
<br /> ordinkainke
<br /> ner 'and/or Contractor)
<br /> - --- --- -----I--- - ---- -
<br /> (Signe ........
<br /> -----7_7
<br /> ------------
<br /> --------------------- ------
<br /> lb�iidin can0�ic�d 6n reverse side).
<br /> L I-1 in 0 S,
<br /> (Plot plajj,.Aii�iing size!of lot,-L'16ca
<br /> IENTi U8 E 0 N Ly
<br /> A FOk
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<br /> 1 7 1 JDATE_�__:---------------------- -------
<br /> r------- - --7-
<br /> APPLICATION ACCEPTED-BY--- "+I! :DATE--' Ll -------
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<br /> . - --------------------------
<br /> REVIEWtDAY__J_:_!_
<br /> -------- ---
<br /> 1--let_.071
<br /> BU I Lbl'�G JPER' E
<br /> Olt 'ISSUED ----------------
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<br /> Alter!a-'tions-and/ip' r-recol 5 ------
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<br /> f-j4-' t r'1-71 Y--t D
<br /> FA L L— "V:------- -- ----------------------------- -------------
<br /> IN iNSPECTION 4
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 3oo West Oats Street -132 Sycamore Street 814 North "C" Street
<br /> 13o South American Street Manteca, California Tracy. California
<br /> Stockton, California Lodi, California
<br /> LS___a_2M 14-4- TwC[3-
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