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' FOR OFFICE USE: <br /> V APPLICATION FOR SANITATION PERMIT FenmitNo. u�^����-- ' <br /> k��m�mfm'� �u��mfe ' <br /> '-....r.. .............--..-----� ` ' Duplicate) Date Issued <br /> � . <br /> Applicationi hereby made to the Sun Joaquin Local Health District for a permit J �Install the work herein described. <br /> This application is made in compliance with Coonty Ordinance No. 549. -67,0 -OL <br /> JOB ADDRESS AND OCATION <br /> , <br /> Owner's Name �� <br /> Address ! <br /> C� .� p� <br /> nn�actn/, Name_... ' -'-'_--__--'_- 000'---.------' <br /> ' |latinn will serve- Residence Apartment rtment Homm [] Commercial [] Trailer Court [] kJo+v [] Other [] | <br /> � <br /> Number of living units:,/,/..... Number ofbedrooms Number ?~- Lot size - ----------------- <br /> Water <br /> ~. | <br /> ` Supply: Public system [] Community system [] Privateto Wafer Table if �� | <br /> Character of soil to a depth of 3 feet- Sand E] Gravel [], Sandy Loam El Clay Loam [I Clay Ej Adobe E] Hardpan <br /> Previous Application Made: (if yes,date. ...... ........ No Ej New Construction: Yes [-] No E] FHA/VA: Yes [] No D <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> DIS Id: Distance from nearest well ,_50... Distance from foundation----/_0..........Distance to nearest lot line.i;� <br /> pil(i Number of lines----------/.....................Length oi each ine_ - --- ---- ---Width of trench_A__,..................... <br /> Seepa it: Distance to nearest well.._./je'a Distance from foundafion---- to nearest lot line--4..... ...... <br /> /P-11 ... 2-_r-, <br /> lP � <br /> Remodeling (6nsc,Ube�:---���x���«�- -.^"���,��-------------.-------.--.--'___ � <br /> �_----_---._'-----_.-_--_-------------'--_-.__-_-----_-__----'_-------_ . <br /> � . <br /> '------------------'-----'--'-----------------'----'-----'------'---'------''-' <br /> _7----------------------------------------------------------------- ����.........�����������������'.......__���... .......... <br /> ( hw, have application n6 that the wu, will be done in accordance with San Joaquin County <br /> ordinances, certify <br /> laws, and rules and regulations of the San Joaquin Local Health District. i <br /> (�igneJ)--. - --------_-__--',----------' wnJ/o, Contractor) <br /> ~-�- - �- --- - -----~------~� <br /> Bv�_( �"��� �� ------_.�___--_---']?�o�-------------- <br /> P �n. �m� � � |� ��n � �rrn ��� to wells, buildings, �� �n � �� � �� �� <br /> ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- <br /> . ............-................................ DATE---- --_ ............ <br /> REVIEVYB) 8Y-------------------------' --'_.--_'_---_-.......... DATE'------_-'_-_-''-_._ <br /> Bn|LD|N5 PERMIT |SSUBI-- ................... ......... ......................^----------------..................... DATE--_'_-__............----__.� <br /> � and/or recommendations:......... - ...... ...... ................................................ ............................................................................ <br /> � <br /> . .....................................-------------------.......................................... ',..................-....................-.............................................. ' <br /> --- ................................... -..... - ------ ......................................-_....................................................................................................... <br /> !------_--_- ....................................... .........................-' ..........................................................................~................................. <br /> '�-'-----'------------------'---'''----------------------------------' <br /> ' <br /> 'F|�/\L INSPECTION 8Y� '_'- 0*�//-./'=�-6x��_----'_--����---'- <br /> � ` <br /> � SAN JC}AQU|N LOCAL HEALTH DISTRICT <br /> � <br /> 160` E.Haxalon Ave, z00West Oak Street 124 Sycamore Street 205 West 9th Street <br /> , Sil"a^". California Lodi.California Manteca,California /racy.c"/f"rnia <br /> iK.vm^`.67 Vanguard Press <br /> � <br />