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� �Ll ^~ <br /> APPLICATION FOR SANITATION PERMIT Permit No_/�Y.74. - <br /> (Complete <br /> � � <br /> Duplicate)— ` Do+o |so»y6 - <br /> ' — /— <br /> Application is hereby madehz the San Joaquin Local Health District for a oper it to construct and install the work herein described. <br /> This application is made in c iance�wh Cou Tty Ordinance N! 49. <br /> 6 W - i by& <br /> JOB ADDRESS AND LOV OY'A 4------) ------------------------------------------- <br /> Installation will serve: Residence M---A�partmenf House Ej Commercial 0 Trailer Court [] Motel C] Other <br /> Number of livin units: --- Number of bedrooms Number of baths __!/kLWt §ize ------- -------------------- <br /> Address License No. Phone <br /> Previous Application Made: Yes E] No New Construction: Yes o E] FHA/VA. Yes W1__1N0 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 weII_,/±�_1'___11---Distance from foundafion--/6--- Material--- ----d-�ZC A---- <br /> Disposal,JKT& Disfance from nearest well Distance from founclafion...�.!�?----/----Distance to nearest lot ------- <br /> Seepage Distance to nearesf'weII__�/_!?A___ Distance from ------Distance to nearest lot line------Is... <br /> Romodeling and/or repairing [describe):-----------------y__j__Z_Lx1--------zsl---sle---1_1__�--------------I--------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance5, State laws, and rules and regulations of the San Jo Local Health District. <br /> (Signed)------------------------- 4 ---- -- - A:P,19!a le---- --re 7 IC 49­�Owner and/or Contractor) <br /> 52 <br /> (Plot plan. showing siz 6 lot. lo ation o system in relation to wells, buildings',—e C., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ---------------------------- <br /> BUILDINGPEKW|T ISSUED-------------------------------------------------------------- DATE------------------------------------------__-_-- . <br /> Al+o,uHnnuunJ/nr ,ocnmmen6aHono----.------------------_------------_--.-------___._________.. <br /> -------------------'----'----------'--------'-----------------------'' <br /> --'—'--'--'''— '''—' ' --''''--'''—''''------------------------------------------------------------------------------ <br /> . <br /> --------------------------------------------- —'''—''''—''--'''--''---'''—'''--''_'—'_'— <br /> FINAL |NSPECT|(J " 4 —�' Dote- 7-------------' <br /> SANJOAQU|NLOCALHEALTHDISTRVCT <br /> /30 South American Street sooWest Oak s+=a /se uvc°m"= s*=°+ m* North ^c' Street <br /> Stockton, California Lodi. California Manteca, California Tracy, California ^ <br /> rsv—cm n"°,edo'5,,zc". <br /> � <br />