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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Dmplicafw) <br /> ' <br /> fi ` Application is 6eny6v mo6o to the Son Joaquin Local Health District for o permit to construct and install the work herein described. <br /> �- <br /> This application is made incompliance with County (3r6/nonc, No. 549. <br /> JOB ADDRESS ANI�ILOCjATION----- <br /> Owner's N A "K��t_ <br /> vie?_ 1_j , -t ----------- Phone--- <br /> ------------------------- <br /> Address <br /> Contract' <br /> or's Name-----------'--'-----'---'-----------'-----------'-----__ rnona_-._________ <br /> / Installation will serve: Residence 29 Apartment House E] Commercial E] Trailer Court El Motel E] C*kor F] <br /> ' <br /> Number ofliving units: Z Number of 6edvnnmx �� Num6�, of ��f6� �� Lnt ,��.- ^���� ��n 4% <br /> / ' �_ ---'_-�`--_-.---.----.-_-- <br /> Wafer Supply: Public system E] Community system E] Private [K <br /> Character of mxU to a depth *{3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loom E] ~ Clay X] Ado6o [j Hardpan R ~ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: / <br /> (No septic tank nrcesspool permitted if public sewer isavailable within 200 feet.) <br /> Septic Tank: Distance from nearest weU../A/1-------Distance from <br /> [� fnun6ation- _'''. '-| 'C-,7��� <br /> ---'N f compartments ��` <br /> iquid depth--.-I <br /> ce"M 0 Distance from ngar sf.;iyeJl_/f��___Distance lim foundation Lining material_A2, <br /> .Privy- Distance from nearest weU---------.-----__/.--'Distance from neon:,f building <br /> L� Distance to nearest lot |ino____._-._____---' - '----------- <br /> Seepage Pit: Distance to nearest welL_____Distance from foundation- ' -istance to nearest lot line�--'-1] Number of—pits--------------------.-Lining.. Uning material Size' Diameter <br /> ^ <br /> Depth» -NDispos | Field: from nearest well ".,.a""= =" foundation--- <br /> [] Number ~ .�. u- a'-- to nearest | <br /> ~ �Lnnn+ of e�c6 |�� ����''- Width of trench <br /> Typo of filter material --------Depth qffilter mo+o�a| ' -` `-'�Y`- <br /> '- <br /> ------ <br /> Remodeling and/or repairing (describe):-----_----_-_--'-'------------------- <br /> -------------------'-------------------------------------------------------------------------------------- <br /> _--__._._'-_.___.-..-�-_-----�__.-_-.______ \ <br /> _----____'__.__--__.-__----__-____--__---'-_-..__-_-_�_..-___-'__.-___'___--_- -------------- <br /> U ---'----'-----'----''---'---''----'-----'-----'--''''---' <br /> hereby <br /> certify that I have prepa red 11is a d that the work will be done in accordance with San Joaquin County <br />| n'mman <br />' Stvis, <br /> '°.m"=" -- ----------.. --'_./�]wnerand/or ��onfraofmr � <br />� �y:__^____.______�~________________._____-___._______ Rlfl� ' <br /> i (»�+ plans, showing size of lot, location of system in relation to wells, bui��u,. etc., must'-----` o''|aJ--'.'this application). <br /> FOR DEPARTMENT USE ONLY | <br /> \ <br /> Stockton,REVIEWED BY 'tl I-- <br /> Alterations and/or recommend afions:---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> California <br /> ES-9-2M v'so W-1639 -- — '| <br />