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` <br />/ <br />l <br />� <br />FOR OFFICE U SE: <br />Permit No. <br />APPLICATION FOR SANITATION PERMIT <br />rein described. <br />Application is hereby made o the San Joaquin Local Heal+h District for a permit to construct and install the work he <br />This application is made in c6mpliance with County OrclinancWeN '549 <br />JOB ADDRESS AND - -------- V� ------------------------------------------------------------------------ ........................... <br />-OCATION ---------- er__- -- <br />7 ---------- 2 ------------------------------------------ ------------------------------------------- <br />Owner's Name <br />Installation will serve: Residence 9T'Apartme�t House Cc , mme�cial E] Trailer Court 0 Motel [3 Other [I <br />Number of liv;ng uni Number of bed.roo�'nri Numbe� r of baths --- L Lot'size -zoex__�Z.!M ----------------------------- <br />Water Supply: Public system UT-�Commiunity syster� E1-Privaf6.E] I-De-pth to' Water' Table 441rf <br />Character of soil to a dept of 3 feet: Sand [] Gravel E] /Sandy Loa.nI-D Clay Loam [] Clay E] Adobe 03"'Pardpan 0 <br />Previous Application Made: (If yes, da'te --------------------- N ew tor�st-.r�u'ction Yes [] No Z?'PHA/VA: Yes No 2;—� <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer i� ayailable'�ffhin 200 feel.) <br />Seepage Pit: Di's'tan nearest well ------ --- ------- Distance fTpm f��undafion--/,-44�?-r.�Distance to nearest lot line-��-/ --- <br />----------- 111k ------------------------------------ --------- 7 ------------- I -------------------------------------- ---------------------------- - <br />I hereby certify that I! aye prepared this application and that the work will be done in accordance with San Joaquin C.ounty <br />ordinances, State laws, and rules and regulations of.the'San Joaquin Local Health District. <br />-andtftr Contractor) <br />(Plot plan,, showing size of 104'. location Of m in relation to wells, buildings, etc., can be placed on reverse'side). <br />--_-----_' .-�� <br />° N ACCtPTE <br />'REVIEWED BY. --_-- <br />G- PERMIT ISSUE <br />FOR DEPART <br />. <br />BY ----- <br />--_._—..-L_.--__-o*|����-_..�-�z-_-/��.`�---' <br />~'--,�/ - f_---___.D/�E------.—''------------ <br />�.--'''''''--'--'-'''---''-_--_Z 772-5r, <br />--------------------------------------------------- <br />- <br />' <br />.--'-'—''---''--.— <br />61- <br />HN/\L INSPECTION BY1--^ D ���---------------------------------------- <br />SAN JO |N LOCAL HEALTH DISTRICT <br />- <br />300 W�it'e.e <br />'^ 000W°m�h�=m <br />^ ` <br />Manteca, California ��==`�~'~~��'m <br />V' California <br />~ <br />1uoSouth American Street <br />Stockton, California <br />" °, 6-613 <br />