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FOR OFFICE USE. - I t \. <br /> )k <br /> .......... ... . . APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------- <br /> .. ...................... <br /> (Complete in Duplicate) Date Issued <br /> .......................... ....... Aermit Expires 1 Year From Data Issued 4 <br /> Applica�fi on is hereby made to the San Joaquin Local Health District for a permit to contjstm tend install the work herein described.. <br /> This application is-made in compliance with 'Count rdinance+ No. 549. <br /> Plq_.� <br /> JOB ADDRESS AND LOCATI �41eie .... <br /> . .....�_­­. <br /> Owner's Name............. --------------- ----------- <br /> .................. <br /> &Wracfois Name--*.. _.•----.---_..---... ...... ­-­ ........ ................ Phonel....... ... <br /> trafaRatich Will seryw. Residence (nAp rnent House E] Commercial E] Trailer Cov4 0 Motel 0 Other b <br /> Number of livingL_ <br /> un!+s:. . Number-of bedrooms a_ Number of bathLot _42<f_.., <br /> pth'f6 <br /> Water'Supply: Pub0c syste Com' munity system Cj Privat-e�9�0 P�v 'K, ft <br /> M ter Ta6le/ <br /> Cla_y� � AlaO fiardw�a <br /> Character Qf sad+v,a iap$ el 0 So ady LoamV,t,_( <br /> 4*iz Sov4 ❑ Gray C14 Lo. <br /> Previous App4tafron Made: (tf yes, No OD flew Coo ruction, Yes"NO 0 F"IA,Yes,D, Nov <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> `{No *Pfic font or cesspool'permifted if public sewer is available wWa,200 feet.) <br /> flispo t Field; Distance'fmm neares# well`J�^+'►W'E9 stance from found tlon�lA -a' ~`Distsnee to nearest lot line-_5___n- _ <br /> �� .__-.-_ Length of each fine ,. � ' `� ��� <br /> Seepage !'its Distance tip-, ......:.-...Distance to nearaHot line.......... <br /> _'Distaoffe.-fearn foundation._ <br /> Number df pits... -F�Ing m8farial.......... .....Size: Diameter.-..--------------_Depth.1........................ <br /> L! <br /> Cesspool: Distance from.nearest well...... Msta4pe ......UnIng materidl+�_.......... <br /> from foundation <br /> Size. Diame.for—__ .......... Liquid Capacity! <br /> Privy: Distance from.ieanesf v/611_ Distance from nearest building.......( <br /> .... ............. <br /> Distance to Inearest-16t line-.,___W ..... <br /> Remodeling and/&,repp!rjn <br /> ...............­----- ...... . .... <br /> r <br /> WU5, --------- <br /> .............. ...... ........ ........... . ...........I...... ........................ <br /> ------------ <br /> ------------- ---------1..................V,........ ............................ <br /> -pfepar�d this 1pplica4f6rr and or-dance WA San Joaquin Ciminty <br /> I hereby'ceAi�,Alt 1.;Aa�p that the wiwk will be done in ace <br /> ordinances, State Paws, and rand regulate of the San Joaquin Local Health District. <br /> (Sign5 gfteJIIr and/or Contractor] <br /> ed_._: � �� —��.,n_�-------------- ........... .........._(Own <br /> BYL ........ --------------...................---------------------­------- ..........ITItle)-----------------------­ --------- <br /> -4 V <br /> (Plat jlan, showing Size of lot, location cf,syprftpn,in relation to wok.buildings, etc., can bai placed on reverse sidb� <br /> 4- <br /> t/ ORI? <br /> APPLICAI,TM ACCEPTED .---------------•--•---.. <br /> REVIEWED BY____ <br /> _-----------_-----_--_­.................. <br /> BUILDING PFAMIT ISUED-.. --------- AYE........------____...,.................. <br /> ............ <br /> ......................... <br /> ............ <br /> --------------t---..•------- ----------- --------------------­------- <br /> ---------------------- - ------.__•____......... ............-------•-•--_------- ------- ........ ------ <br /> CT <br /> FJNAL�WspbsaQ <br /> SAN JOA.�Ulk'WCAA,THEALfHZ DISTRICT <br /> 130 South ArnorloqmStnN* 300 West 009 Stream t24 Sycmwre Strati 205 West 9*mroo <br /> Stockton,Colff*rnio Lodi,California Manteca,California Tracy,Wjtoh <br />