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' <br /> �� � <br /> L� ~/ <br /> APPLICATION FOR SANITATION PERMIT <br /> / ' <br /> (Complete in Duplicate) *-qo4l <br /> 0 [v <br /> A Hf � n,trucon <br /> Tot6 install the work herein 6oscr|6o6. <br /> supp|icp+ivn ^ <br /> i, mm�o incomp|�mnce �it� C�un+y [)r��nunco No. S4�. \ <br /> / <br /> FF� '� . / / ' <br /> JOB ADDRESS <br /> Installation will serve: Residence Apartment House Commercial Trailer Court E] Motel E] Other F] <br /> Number of living units: [1] Number of bedrooms [r] Number of baths T Lot size---fN <br /> Ai <br /> Water Supply: Public system E] Community system F1 Private EL <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__1_00_P_�4Distance from foundation---�0�I---------Material---Cim---�_ _e <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building---------------- . <br /> El Distance to neomof lot line i--'_--.�-.--��__� 8�~~ <br /> Soeouoo PK: Distance to nooroo weL--''''-_'Dishance from foundation--------------------Distance to nearest lot line--'-_._- <br /> [] Nvm6ar of <br /> -�70isipo,n|- Fie|6: "Distance from neo,este+o'ne*n,,+J f;-Ii ` <br /> Nwmb:r of lines-----/---------------------------Length of each || Wi�6+h of trench-a-46-1-1- ' <br /> Type of filter maferiaLRaCA-------------Depth of filter mu+o,ia|]x��_---.. <br /> ' <br /> Ramo6eling and/or repairing (describe):------------------------------------------------ -----------I——------------------------------------------------------------------------------- <br /> - <br /> ! <br /> -----------------------------------------------'------------------------------------------------------------------- --------------------------------------------------------------------'--------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------_''''-_'----'---`''-_---___---__-__.-----_.__.__.-__ ! <br /> I hereby certify that | have prepared this application andthat the work will bedone inaccordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Lwwe| Health District. <br /> ~�~ <br /> (Sigoe6)--. ---_----------______--._ and/or <br /> , - '-- --'n`~ --- of lot, location— of system- in� relation-to._ wells, buildings,-�� -_`�must~_- filed�� with ^his- -rr'-~^-r � <br /> { <br /> FOR DEPARTMENT USE ONLY <br /> . � ' / <br /> RBUEVVEDBY------------------------------------------------------------------------------------------------------------------------------ DATE.--_-__-___._-______ <br /> QU\LD|NG PERMIT ISSUED---------------------------------------------------------------'''--''''''-__--''' DATE-''---_--'''-'-'-'-_______ <br /> AKnraHonyan6/mrnocummmen6uMona:_-_-.- ----_. -----------__-.-----.-______.. <br /> --'------'' --'- �=='-'-=-�`='"v--------�-------'----�-------------------- <br /> joe <br /> -------''�r-'------'--'---'--'-�------'-------'---'-----'--------------------'—' <br /> '----'''''---'''---''--''---''''--'''''-'---'''--'------''''''----''''--'''---'''''''''--''-'--'-''- <br /> _______''~________'______'_____'____'_________'___________'__________'_'__�' <br /> PERM|T No__' '|S3UEn f -'-�''(Do+o) FINAL INSPECTION BY ~~-- -'� <br /> Date--------------- ,�- --------------------- <br /> , <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> ~` |30South American S+n°o+ <br /> � . <br /> Stockton. California <br />