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2­�--- &._4 APPLICATION FOR SANITATION PERMIT Permit No. ../....ZZe2 <br /> (Complete in Duplicate) Date issued <br /> --------------------------------------------------- <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby'made to the San Joaquin Local Health District for a permit to c nstryct an instal the work hp(ein described. <br /> This application is made in compliance. with County Ordina. ce N o., 549. <br /> yraina <br /> JOB ADDRESS AND LOC TION------- - -------1.4------- <br />� np" _____ Phone— <br /> / <br /> . <br /> -------- <br /> Contractor's <br /> |n�wUm|�n will w�r�°~ ~`~'~~~~ [ / Apar� ont House [] Commercial �r Court [] Motel [j Other ]_'_'-- <br /> l <br /> Number o{ |^�`�^ng m^�^1�� Number nf-6e6,o�ms '—.. Number of baths —_ <br /> ' Lot o�m . <br /> Water Supply: Public system 0 Community system D private E�r`Uepth To Water Table <br /> k <br /> r'+ <br /> ' <br /> 0 <br /> Character mfsoil to m ��'�— �� feet': Sand E] Gravel [I Sandy Loam 0 Clay Loam [I Clay 0 Aclob; Ej--Hardpan <br /> Previous Application Made: (if yes,6/ote---. ----;.) No �?' No~ Construction: Ye, m� No [] FHA/V \. Yey [I No E� <br /> ­ <br /> TfPEJF1NSTALLATlONAN0SPEC\FCAT\ONS <br />� | �� 6 � b|� � ihm6|w*if\�m 200feet) ~ <br /> � `- -' ' ' le ����� _­..... <br /> Septic Tank- Distance from nearest wellO.O.------Distance from <br /> � Distance from nearest well_ZPA_.' f 66 � <br /> fou � . Distance no o=w"=" lot line.. <br /> posal <br /> ' Number of |i000 - ------'-u»99`» of each "''e—~~''~--'Type of filter of filter material--- ��---- i- ���� / <br /> length <br /> � esfSeepage Pit: Distance to near ��| x���� uoufrom foundation---,/!?-----------Distance to nearest lot line,..(S --- <br /> Cesspool: Distance from nearest well-----_---------Distance from:founclati ap ------ <br /> LJ Size: "="'e'e'---'''—'-----'--Depth—� Distance from nearest 6u86�nn ------------------- <br /> ---------------- <br /> Distance <br /> -- <br /> . p ' ` ' Distance from nooremw=|L—_—_—'—._----._.__________________�__ ��___-______ <br /> [] u/muncwro nou,o� /c" line--------------------- ~,`-,__� <br /> ' <br /> . . --------------_.___ <br /> | ''—'����� <br /> L '—'---'--''--'—''--------'---'---------' that +h� work �0 done U` a���,�mnw� with San Joaquin �nuo+y - <br /> I hereby certify that I have prepared this application zind <br /> 1 mp6��n�m� State laws, and rules �v6 regulations w� �ne �m� �omqum �==�. ,.=""" =~�.~. <br /> ' -----------�� '{ _. - +m Wells, 6uU6��� m+�. can <br /> 6o placed on reverse side). - <br /> � ��f , ��w�� size of lot, ��a�mnmf �ys�mn r�mnpn w..~ . <br /> � ArruCA/.w.` "CC" '^" `'-- �� --"~—'----- _- ---------_----------- <br /> DATE---'---------------' <br /> ' REV|E\�ED 8Y---__--._.—'—'—.''----------'—'-_--''----''--'-- ____._ . <br /> BU|LDUNG' PERMIT ISSUED.'__---_--'--''—''__---'----.—_--_—.—_-'_—.' ",''^'---^_'—''--- '' � _____ _ <br /> AMerwMmnmmn6/mr _—.—_--_--___—___.—_-___.__..__________.____.__._________._.. <br /> | -__----------'---'—'-----------------'-----------'�------------------------------------------------- <br /> -__ ____._____.� <br /> ---'--'—.'''—'---_— _—.'''—'--''''—'---''—''—''—'-'---'--''--'----.— ---''_---'—''—'—_.--'--.'' ` <br /> / --._.—.—_--_-----_---_------._--�'' �---' -_---------_----_----_--_—.—.. <br /> _____________- ___ ___________ - <br /> | � <br /> Dot� —��/� �������—'�----''—'''—'— <br /> RNAL INSPECTION 8Y�—''~,��'~�.�'��.--���'—'--- '—'' <br /> SAN J��AQU|NLOCALNEA�HD|��CT <br /> 1amow"mAm�/=""��e' a0wW°mOak onw° ^ 1o«ov�mweo�w , 20u�° ^*�m�° <br /> �� California = ~ � Lodi,California Manteca,California �*"v'w"ov�n� <br /> ^ - <br /> ES ncwscuu-o, <br /> ' ^/ <br /> �LA <br /> � <br />