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' ^� . <br /> 1 <br /> v�~ � <br /> APPLICATION FOR SANITATION PEWIT �nn� No /. d /�&_- � <br /> -k <br /> (Complete |n Duplicate) <br /> Do+o |sm^m6 ' <br /> plication is hereby made to <br /> e ��n Joaquin Local Health �i�r�t �xo permit fpcnn,�wxtonJ install the �or�n <br /> |mxupp|icutkmismode in compliance with County Ordinance No. 549. <br /> . <br /> JOB ADDRESS AND <br /> ^ _ - LCC \T| N ^ <br /> -- ~ . ~'---'---`-' <br /> [wner'o N /`- ---,�_ ------.-M---_--- Phone----.`-_---.-.. <br /> w���raa_ _._. ---------------------------- <br /> R <br /> _________. <br /> `~~ '~- ~ ^ Name-''--'--'' ^ ''=`- �------------------------------------------------------ --------------------------------- <br /> Phone---------------------------------- <br /> Installation will servo: Pesidence E] Apartment House E] Commercial �Tr |er Court [] Motel [j Otho [] <br /> Nu`n`bnrqfliving <br /> 'units: -------- Number ofbedrooms .:--- Number of baths Lot size .----------.-- <br /> Water Supply: Public system E] Community system E] Private E--Depth to Water Table <br /> | <br /> Character nfsoil tom depth pf3 feet: Gravel uvo| [:] Sandy Loam P, Clay Loam El Clay [I Qmndpon 171 <br /> Previous Application Made: Yns N�� (�onsfruct�on� Yes mo^�No E] FH/\/VA. Yoo [� Nouo~~- <br /> �� .,. �� , � . . <br /> TYPE Of INSTALLATION AND SPECIFICATIONS: ' � <br /> ` ~ . <br /> 84o sepHc tankp,'nesqomn| permitted R public sewer isavailable within �20O <br /> Dis I �eld: Distance from nearest well. Distance from foundation-----!�J----------DjsfanC'(3 JO nearest lot Iine___,/_1i------ <br /> Seepa Pit: Distance to nearest welf-44S---------Distance f foundation---/A-------------Distance to nearest lot line____S <br /> � <br /> [] Distance to nearest |u+ |ioo <br /> . <br /> Romo6eing and/or ncpoi�ng �a��6e)�.-'' ''--'-''-'''___�--'--'-___---_ <br /> ------------------------------------------------------------ ----------------------------------- -^-'_-.-'�---------.----.-------------------------------------------- <br /> ---------------------.---------------------------------- � -_` ^_. ^ - _ . ~ <br /> | hereby certif� that;4ave ��eparecl this appllica4on and fha't'-4�el w6rCwill be,done in accordanc� with San Joaquin County <br /> ordinances, State laws 'nC1;,.rules,an egulations of the San Joaquin Local Health District. <br /> (Signed)-- A�---. 77 ----m--- <br /> (Plot plan, showing size of lot, loce f system in relation to wells, buildings, etc., can be placed on rever�e side). <br /> FOR DEPARTMENT U�E ONLY <br /> xrruC^//um ACCEPTED <br /> 4 o, -17 <br /> --.--.---_—__.-----�'' _.. <br /> REV|EW�D 8Y' ------------ DATE!''''-''' .��'.--_--'--.--L <br /> BU|LD|NG —__ <br /> PERMIT |SSUED-__._-.__--_--_---__--._-.-_-___ D�TE-'_-__-_----__.___ <br /> and/orAlterations <br /> - _ — - . ''- '--'--'--'----''--- <br /> _-_—.-'_- - ' � l <br /> ------_-- _-_ _--._ _--.-�- <br /> -_--------.—___-'--_-.___-.. <br /> _______ <br /> -----.'-'-'--.''---'----'''-'_-''-'''--'-- '�-''''_-''--_----''--'-----''--''-''`-''-'_--'- <br /> ' <br /> ---_'- '---'-'-''--''-����--''-''------------------------------------------ <br /> Date <br /> '--''-'--'--'--' <br /> . . <br /> �N�L |N�PECTx� \ ' Dat'_____ <br /> - / <br /> SAN JCwWJU|N LOCAL HEALTH DISTRICT ' <br /> /nn� sv"m American Street 30wWest Oak Street /zx Sycamore Street m* North "r' Street <br /> Stockton, California Lodi, California Moom^a, California Tm*» California <br /> ss-p-ow nv,a°a 1.57 p�,zo- <br />