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T 1-UKOpFI <br /> ! ^y / ' « <br /> APPLICATION FOR SANITATION PERMIT Permit No., <br /> -------------- This Permit Expires I Year From Date Issued Date Issued ..../A�4,7Application is hereby 'made to the San Joaquin Local Health District for a permit to construct and install the work herein descr <br /> / <br /> 7 ".~ application <br /> JOB ADDRESS D CAT <br /> ^ ---- - ---- Ax-7x�-6------- <br /> ' <br /> Owner's Name_" `���� <br /> - � —''-- Phone <br /> Address <br /> . - -''_-- <br /> Coo+mctn,� Num*---____. \ �����--'--'--'---'-- <br /> * . ___� ------------------------------------_ ..��—_ P6on�-_------.......... <br />� <br /> Installation will ��: ���� �m�� �� � � ��| � ��� �� ' <br /> �� '`p~ m rt [] Motel [] other <br />� <br /> Number ofliving units: .j--Num6orofbedrooms 'PZ. Number of no+h, Y. Lot size .-'~m^�. <br />� <br /> Water Supply: Public system [:] Community system E] P�,m+n'�� Dmp+6n» \Nu�r ` 6|e ' � -- -------- <br /> --- <br /> Character of soil tom depth of 3 feet: Sand ElGravel 0 Sandy <br /> Lo [] Clay Loam [3 Clay J-] Ado6ey� Hardpan � <br /> Pre°�ms Application Made:. (if yno'6oto----.----j No Construction: --on' Yes [I No ' .�~o No [� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No segfic tank or cesspool <br /> �6m7�o6 if public <br /> ._sewer isevmDmb|ww�hhm 200 feet.) <br /> Distance from nearest weU.-,'---. D[�onco from foundation-------_-------- <br /> No. of compartments _Material --------------- <br /> _--.'� S�o__' _---L|qu}6 6ePto-----.---Copuci��-_--'-_- <br /> D�+o 6n 6�.......Distance from foundation...t-3 .......Distance to nearest lot line.,/e <br /> / <br />. S.. . °~.a"cn to nnom�t <br /> Number of � <br />' -----------Linin 31-_f Z01 i <br /> Cesspool: Distance re, well----------------- from foundation--' Lining material.- <br /> LJ Size: Diameter �'-''--''-'''---.Dopfh'--''-'---__.. '-'--Uou|6 Copo�.''---'-''--'---b <br /> � '---.-- . ----_---__gu- <br /> ^ 'rnvy� U�f nce from ^oun,� ~uU''-_�'''-----'--------------Distance from nearest building <br /> L� Distance to nearest lot |�o-''_ ''=-''-''-----''--'- <br /> . I -,---._._------ <br /> Remodeling -n6/o, repairing (describe): <br /> | <br /> -----------------------------------.._____._-_--__---'-_-..__'__.'-��''-_. -------------------------------- <br /> --''---''-'---'-'-__'__--L__'-__..___--__-.--___.____ � ---''-----'-- ( �� <br /> ---_-__._-.--_-'—.-_1-_ -______.--_-._-____ __...--'---_--__-__--__----- <br /> - , <br /> hereby c ' that I have prepared this application and that the work will be do,n--e---in-"accordance with San Joaquin County <br /> ordinances, VateAaws,,a%1l rules an regulations of the San Joaquin Local Health District. <br /> V*- , r4-_.45� <br /> (Plot plan, showing size of lot, locaflo� of sy em relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> u�s '- . _- —�' -----°-- � <br /> = <br /> --------- <br /> ---------- � � .. -----77-r------ _ <br /> .�. <br /> -_-_-.. <br /> ----- -' --- <br /> - - ._ . '-'- ' - _ <br /> -' -- <br /> - -' ' -' .------------------------ --�_ ' -- ' '''- ' ----------------- <br /> 1,41 <br /> - -- <br /> RNAL INSPECTION By —//— <br /> Date-___.._-_--- ------------- _� . <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT/n0 South American Street o0nWest Oak Siroet 1u4Sycamore Street o0yWest 9th Street <br /> u*mm"'California Lodi,California m*nte,w'CaliforniaTracy,Californiay REVISED 8^59 uw o'ac xrL^o <br /> ` <br /> ' <br /> ! <br /> - <br />