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^ \ ` <br /> ^� APPLICATION FOR SANITATION PERMIT permit No. ���� <br /> k�n�m�to �n ' <br /> ` ' Duplicate) <br /> � - <br /> Do+o |mmxy6 {/��� -_. <br /> T � San ' Health Di��c+6napenn� +ocon�mctand � +�Uthe wo,' herein described. <br /> n���ut�n |s m�6m [n oumo|�n with County Ordinance No. 549 <br /> - <br /> JOB ADDRESS AND ATI <br /> ^ <br /> . � <br /> » <br /> Owner's Nam <br /> """' -11 <br /> -------- <br /> Contractor's i` <br /> Name ' � <br /> Installation will serve: Residence [_]"Commercial E] Trailer Court [j M ofel 0 Other [] ` <br /> 'Number vf living' units: ../- Number ufbo6room,~�» -Number � _-.___-' ' <br /> ' ' - 4-- <br /> W�,.S�c�: �b� ��m [] Community ��m �� ��t �+ D�� � Water fL , <br /> ' � ~ � -- <br /> Character of soil to m depth of feet: Sand [] Gravel E] Sandy Loam El Clay Loam El Clay E] Hardpan [] <br /> Previous Application Made- Yes E] N New Construction: Yes'�71 No El ~ <br /> TYPE OFINSTALLATION AND SPBC|F|C' |ONS: ' U <br /> U�m oom|ic +ankov cesspool parmhfa6 if public sewer is available within 200 feet.) <br /> ' <br /> Septic Tank: Distance from U <br /> | Field: Distance ­����- ^ Distance to nearest lot + <br /> Numb~� ' � eac ' <br /> �`' <br /> � Width~' -----. 'Typu �f filter ma - <br /> P�� Distance to o�unod wu ^ +o noun�t �t |�o-' *� ' <br /> Number of pits / .. Lin|ng materia�� - - - � <br /> ' <br /> Cesspool: Distance from nu*n,� we|L''-_-''-D;�onca �om foundation-------------------- mut*�aL'-'-''-'_-_'_ �� <br /> [1 Size:.Diameter----_-----"--Do�ih--- r _ Uouid~Cupuchy '----._-_g*6`--. __-- ------ <br /> Privy: well <br /> � <br /> Distance from neo�s ��U�-''_-'-_�-''--'�_Dbt..-Distance from no�na+ �wU��g -`---'-_'-______ | � <br /> Distance to -nearest lot line` � ` __-___--__-.__.__.__._____ <br /> . ^ ' <br /> Remodeling m6/o, J <br /> I hereby certify that I have prepared this application and thaf the�;ork will-6e done in accordance with San Joaquin County <br /> ordinances, State laws, an4 rules and regulations of the San Joaquin Local Health District. <br /> (OwneL-!20/or Contractor) <br /> . � . R . _ _--� ^------ <br /> �e � _�~ �� �� 6� ,�ed <br /> � '�_----.� _ � <br /> `�� ��^ ~ �� *f � ��o of � ��� � reversesi <br /> � <br /> F_' _- '---_- USE ONLY <br /> APPLICATION ' . <br /> REVIEWED 0�'''-'--''----��'�� ----- '�'''------------------------------------------------------------- <br /> BUILDING PBland/or��O' |SSUED_---.-�--.-.�------._-.._�-_� -.----_-_ DATE-.---- � <br /> Alterations <br /> �''�-'-�-�'-''--_'-}-' _-.'-_-''-''--'-_-'_-._-__.----_-�--__.__, . <br /> �-���.--'--''''--'`'--'''-''-''--''-'''-'''-'''-''�'-----.''_---'''''_''--''--__''-_''-_-.__.__.- <br /> ~. ^ , ^ <br /> -------------------------------------_'---------------------------------- ------------------------------------------------------------------ ____--------------------------------------------------------------- <br /> -__`_ -------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- <br /> �-''--_'--���--'''_'''_''-''_'-'''----''-'''--'----',_����_---''--''-'''-''---'_---'-'_----' ! <br /> r2 <br /> FINAL 'INSPECTION 8Y:--- -------- Do+e.-.3---------- -----------_--------- <br /> SANJOAQU|N LOCAL HEALTH DISTRICT .. <br /> mo ovom American sv=^w 300 West Oak so"=* mz Sycamore Street ow m"** ^c' Street <br /> Sto=kfo". California Lodi, California ` ' Wmn+"= California n""» California <br /> � <br /> ES-9-2M no.is"d vv:/cm ~ <br />^' _ <br />