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� <br />j <br />Nu��P[]������^��� SANITATIONPERMIT <br />`- <br />VCo'mm�t��n�uoUcafa Date |�uo6 <br />- ` <br />plicafion is <br />horo6v made to the Son Joaquin Local Health District for o permit +uconstruct and install the work herein described.|hisopplicutiqnisna6u <br />in compliance <br />_ ~~ <br />� JOB ADDRESS AND U3 �~y�J�� &/-._.___� <br />, <br />-----------------------------------------------------_._`_____.. <br />uwn�r�� Name P�ono--,y141"IL.=�-_- <br />--------------- ----------��--------------' <br />���mo"-------.----./-.��/����--'-o_.�_'Lil}��------_----.----__-`-.----------_.---------.-.-.. <br />------ <br />` <br />� � <br />Contractor's Name ''-__------��-'''�=�-�.'�'���'-�-.z'-'-'��-'''' Phone ----------------------------------- <br />Installation will serve. Residence �Apartment House E] Cn=morc|v| E] Trailer Court 0 Motel [] Other � <br />Number nfliving units: '�-.. Number of bodmoms��_/. Number of baths ��/, Lot size -_-4/�-y../'.�7<y-.---_---.-' <br />' . <br />\N afmrSu6�v Pu6|ic systemVCommunitysystemy �+�m [� Private E] "'Depth to Water Table -.^.. ft <br />Character nfsoil to depth of feet: Sand [] G,a4 ' Sandy Loam El Clay ^m[] [1uyE] A6n6o pmn [] <br />~ <br />Previous Application Made: Yes [] No oc�Now Construction: Yes [g -~Mn E] pHA/VA.Yes [] No P -111 - <br />-~/TYPE <br />TYPE OF INSTALLATION AND SPECIFICATIONS: r ' <br />(No <br />� <br />septic tank or'cesspool ponn|Mm6 if public sewer is available within 200 feet.) <br />`~.~ <br />Septicnk: '|Distance from nearest we||-�-' Distance from foundation -/ A /---Mn+orio| —- <br />No. y ..... ._-:Liquid depth --- ^~--..Copocify--G/g.-' <br />- <br />-_ofcumport_mon+s--7z��----..Sipa <br />Disposa| old: [s_ from __y�line­-,5--1­.-.- <br />-(7 <br />/ <br />m bor»f ^ -3Length-of each |� J� <br />/y ox x��, mo��rm/-x»xm�.--.-u�pm c� m�or monano|-.z�'__-.|o�| length '''»�8��-'-----'- <br />--. <br />~~ <br />Seepage Pit:� �Di - to -nearest weL-'''^-�-�D��nco from fnundu�on_-'--__-Distanceh, ne*n�+lot |i�o----------------- <br />~�� ( <br />�W ( <br />[] . Number cfpits ----------------------- iining mater�L-._---�----S�o�Dlamefer-.-'--_-0eofh---.-.-'------ <br />� <br />Cesspool: Distance from nean�tweL-----Distance from foundut�ion.r-_..----Lining material .�------.--_ <br />` <br />[] | Size: Diameter -------------------------------------- --'''-''''-'_�- -��'�l_.Gouid Capnc�y'--'''-�--'.gu|� <br />- ~ <br />/ <br />. <br />Distance from nearest well . Distance' from nearest building -------------------------- <br />----DDistance <br />,- <br />fo <br />idancefo nearest lot line ----------------------- ----------- ���,�'^_.��.__.__________.______.______. <br />� <br />� Remodeling and/or repairing (deic,bel: ---------------------------------------------------- --------------- ------- ---------------------- ----------------------- �_---.-_--. <br />=�0 <br />--''__'_-----_-_-____'-_.'''-____--'-_-_-.''--'__�-_.- -'^-_____----_--_.-----'_-.. <br />. ^ �'Y <br />-���--�'^---''-'-`-'-------''-^----'------------''''--'----r---------'---''---'-'—'------- <br />--' <br />. <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />~� <br />6r6ina <br />^01(Plot <br />----- - - - -------------------- 10 ------- -- -- - --------------------------- ------ ------------------------------- ---------------- (Owner and/or Contractor) <br />plan . shh wing.size of Illot, locafion;systern in relation f�o wells, bu . i . Ildings, etc.. can be placed on reverse side). <br />FOR DEPARTMENT USE ONI:Y <br />APPLICATION ACCEPTED BY -.^v ao�/�------------------------------------------- DATE -------- � <br />1:ZO'/^\�� ^ <br />r ' ---- <br />REVIEWEDBY -------------------------------------------- --------------------- ----------------- ---------------------------------------- DATE----___--_--_--____. <br />BUILDING PERMIT |33UED-_--''_''-----'''-.''�-�'----'''---'-'''''--' DATE'''_-''---__'-�-'''-''--'- <br />Alterations and/or recommendations: ---------------r -------------------------- -------- .------- --------------------------------------------- ------------------- <br />� _�� <br />�� �m ~ <br />,y `r ----r---- _----'-''�r'--------'----'--�----------------- ----~^~----~- <br />----------------------------------------------------------------------------------------------------------------------------------------------------------- ^ <br />_-.-------------_---'_-----_---_--.--,__-_------------------.-----_'--' <br />S/kNJOAQU|NLOCALHEALTHD|STR|CT <br />/zu South American Street 30D West Oak Street /32 Sycamore str°=+ ow mo*k ^c^ s*m° <br />Stoci+on, California Lodi, California Manteca. California Tracy, California <br />ES -9-2M - n°.isua 1'57 r,p-Co <br />