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<br /> PERMIT.' ,,,-,.
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<br /> ----------- - .SANITATION ' :........ y
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<br /> . .-.__, • __ . _ •. __ ____ . . This Permit Ex ires 1 Year From Date,Issued �nd
<br /> :.App�italiorn i5 her6by madg fo-the San Joaquin L of ealfhP District f"or a pertni+o construc a# ;Il the work h ' escr'bed.
<br /> f IJ. This application is made
<br /> in''gorri Ilan e wifh County Oirlgnce No. 549., "®
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<br /> • • „JO��ADDRFSS. t�fD �T ON'. �_
<br /> zP :Owner s'Namet . `" bane n;..
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<br /> Address'_ y � ` ---
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<br />., onfrattor s� Name - ..... .` - - ------
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<br /> Ins fl' ion will serve:'�;Resfdepc" artmen# F use= 'Comme�ciaf ®'- yTrailer• dour# of Other `
<br /> ,dumber o�l4v-irig•uaits ., Numbai c o s .• ...'I m110o�f ,baths. !--_."L�ot•.si�e = ''
<br /> Water,Supply: 'Public fiyste�rri; • 5mmurt i syst6m 0� Priva De h' ,�?I�ater T•ai e it '
<br /> Characir of shit llepth-o feet: eSand © Gravel [� S�riafai Q. ay foam �].':Ela . fcddt�e ;• Igrdpan '.
<br /> . #, ,�_�.r•y-� � > '•` �"�i..; • �' � ,-
<br /> ; reyiou ,Applica#damade:'; ( "st date _. } ,No�]!. mow`^Corisfl uctlon: Yes IxJo1dA/V4les � E].
<br /> TYPE'O NSTA{.L,4 IQN.A D 'ST*Ma RCA:1116AAS:
<br /> { q segj�k- ank or,•f�sspool i public,sewer is available 9ithm j0d fe�t'p T. : •" � -' ' a
<br /> ptl ank:. Dice from nearest,well.___ __ Dista rice from fountimn _.-__ ar�l +� _ ..
<br /> ,. �• of:compgrtrnent y - `
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<br /> - �i '� ' t .r:• ',, r �IRi'k'��'�tit•► .{ � .
<br /> Disposal Fi d: :Distance from eaWf'`wefi,4576._.._Distance from foundatioA �. ',,D '�� f� � kr of n � _
<br /> Y Niimbe� A I riffs. -. ---:. , _ Len th of";each line,_ r_ • chi, 4`i
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<br /> -' F1, • Type of,ffer,. atenal_ .e' D th.of. fi t r a lal- _--• •fo al. I n :, - --_-- �r
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<br /> See a e Pit: 1�lumDisf'abee'of ��5 refit well•'`Lirtl '�* te a aT.rom foe�dS ze n --- --- Y Disfa�cetorleatfr 1 i4 +,¢�'y;
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<br /> esspooi Ulstanq. om nearest well _ i.__ Distanee from foundatbg` l�inln 'material_ ._ V}
<br /> •� 5tze' Q riveter--- --+'.-- ',. Doth _ --Liquid .Capaci#y
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<br /> g .f rvy: r y Dls#ance" m�' restrwgll` ---- --- -'-- Distap�re from 'nearest building � � �, �I
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<br /> Distate fo nea�sfot:llne ` -+ -
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<br /> Rempd1§ling and/or. ,tepalnn esc'r'b.- -- ------------
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<br /> ! hrel�y?eer#ify,thffit I have ,prepared this ap Jication. d that he vrork witl be done in acdo�dan y 'T oaq�iri-Canfi f�
<br /> ordinances, Sia , andriWos a`r► r uiii%Dns�df''-th%San,Jaaquin Local He'alth-Districf:
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<br /> Plot larl`, sho sizv'6f lots 10"' ionApof s s+er"n� etio�•to wbllr-L uli clin etc. can e,
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<br /> APPLICATION ACCEPTED BY h_:_�_,• ,y._ r.t .....- - �'''--
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<br /> R.EVIEWED BY I --
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<br /> $lifLDING PEF MIT 155UED-- " '.------'- '-....'_:_ �. b d
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<br /> Alterations-and/or'rd'cornme-ncl'� - ----------- ----- :ell -s*-----------------. S - - --- ------- ----
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<br /> Date
<br /> a _ *- `••.�'-:
<br /> FINAL INSPECTION BY:
<br /> = Date----__ ,."a
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<br /> SAN�JOAQEIIN LOCAs"HEALTH DIST CT
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<br /> 1601 E.Ha:ell6n All* - •300y1Ne*Oa' S+reel .' 124 Sycam �• 20'4v.st.9th Street. } ••.
<br /> •Sf•cklon,Califia Lodi,California Ir += nteca;co' ra"• $RF{acCalifornia Y Li'.ti
<br /> £5 9 REVISED B-54 3t3- S f.P.0 D. . ♦ •X�.}' r} 1,- •.r C '' •'��•
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