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..... : APPLICATION FOR SANITATION PIRMIT _ ------ ------ ----------- ( plefa is Dupkoej :: _ -::` Dow l�l►ad :::::::::::::_::-::: .A�,liaaft" I€ ha€®bf fn@da #a the Sar, Joaquin mal baatfh Dlif€ic#16F 0 P@Frait to f*a§tFVG#aftd iilftll the W harain dMri , OhYAlt U811 R-afe 'limed l§ SPOW10ft If fRad@ is E-Or Plid aa'w1A C4ufl4y Ofdiaew N@r W: AT �:: . 5... . _..__ _.�.. _ JOS ADORN - - _ /..`.�---. -� ..... Iflofil " WIli APSORIffi# FIHmbw af living gnjtfi.= `fbek&(bv*68 :r__ R6b€-&f.690§ : u#§W MaFal: @F ef tail to a d8p#li of I #@@t3a � ,�€ovala �Lia �, Loam 0 r(3 a a€doaa 0 PF@ASU§ Applies#" Made: f It Va§,defe-::`.:�:::::::::.I I He Gm§W@tice= Ye§ WIN& C3FNA/VA,ala§ C3 No 13--l' . INe §@R#C- #8418FF awaalpifi##ed � palb §�iv49 if avanso WAinI int) §ep#i6 fiaia = @l 8RC-8 f€aFP fi#a1@§ well: : ®i§# :::::f N8. �€ i :::::: yid dam AA Di§#aneg 46ffi,Re §# aaall! :�ONO@ f€ef f8U§da41eP:: �P:`:::��i§ta�a :::�-:--::::: -��_��-:�YV.id#� matenaf lengt Seepa Pit: Di to ce fo nsares4`well_:__ f ..____Distance fromrf undo#ion__r�__._.__.Doistance tohneares# of fine, .jar ----------- Number of pits_` .dam 1 Lining material____ G{�:__:.Size: Diameter_____,- .l......Dept h_.....�? r............. -4 Cesspool: Distancetfrom ne rest ell Distance-from founde#ion--------------._f__.Lining material_________ _ ____ __ ❑ Size: Diameter- 9-"° ------a---------'De #h----------------------•---•------------------`-' Li quid Capacity...-, gals. Privy: Distance from n�arestrwell ------------------------------------- ----------Distance.from nearest building-----------.-------.--------•-------------. ❑ Distancetp net%s-tt4 lot- a ---- ---------------------------- ----------------------- Remodelin -=---� ---••------.._...------------•• --•--------------•-------- � and or el ai � � .. _ -------------- - - 1 - `'- -- F --------------------------•---------------------------------------------------- �.- :-=n_-».Y-- g�- I hereby cer+ify that I have prepared this applica#ion and that the work will be done in accordance with San Joaquin County ordinances, State laws.' and rules and'r gula#ions of the,San Joaquin Local Health District. # od Si n 9 r):; :..,/1 - --•--- : --- --- ------------- - ---- --- --- -•• (Owner and/or Contractor) By,.__...... =—��.._.'. a� .____---- - -- -------- ------------(Ti+l .. -----...._.-- - (Plot plan, showing siae o lot, location of'S em in relation to well ildings, etc., can be placed on reverse side). I q FOR DEPARTMENT USE ONLY $ APPLICATION ACCEPTED BY E ------------------------------------------------ DATE` r� .:. ------------------------ REVIEWS© BY - ----------------------------;-------------------------•----•----------------------- DATE.1....... BUILDING PERMIT ISSUED----- -------------i---------------••-•----- ---------------------------------------------------- DATE..... i %kj >� Alterations and/or re nd tions:.. - ------ - ' .. �t� ----------- ------------------------------------------- ---- -•------------------------------------------------------------------------- ;o -------------------- -------- .. . - --- �•`•/�`- = �' 1�``'i `T �� J�'-----------�~ C�y -'• ( �• f F�F..---------_-- ------ -----• ----•----------------------------- -- - 1 ` 1 ---- ------------------------------------------------------ --•-------------•-••-•-----._........... ... = ------------------------------------------------- .................a t r � T HNAL INSPECTION BY:... ...... --- ----------- Date__._Z `--le ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 4Th Street Stockton,California Lodir California Manteca,California Tracy,California EN 9 MVIOEa 8-59 8M 5-691 ATLAS