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APPLICATION FOR FOR SANION PERMIT Permit No.��.��_ <br /> (Complete in 'Duplicate) Do+o |souo6Application <br /> / <br /> is hena6v mo6n to the Sun Joaquin Luoo| Health Disfrict,for a permit toconstruct and install the work herein described. <br /> This application ismade in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION ,1 ��.. -------------- <br /> ---- . _. __. -_- <br /> ---_-_--. _---.. <br /> (Jwnm,o Moma-'''' --------- --''-`-----''-''''--- Phone------------------------------------ <br /> Address <br /> _----__._-.--' <br /> __ --------'----_______-.___'-_-----.-----.---_--_-_-------'_--_----------'''---------_.�----' <br /> ; Contracfor, Nume_ __^__-'_.-__--_--_-_--_--__-- Phono--__----__---' <br /> � <br /> Installationvill serve: Residence rtmenfHouse [:] Commercial F] Trailer Court Wofel [:] Other E] <br /> Number ofliving units. )--. Number ofbedrooms ---- 6ar of baths )-.. Lot size'.. I ------------------------ <br /> Wafer Supply: Public system unify system J-] Private 0 Depth to Water Table -------- ft. <br /> � <br /> Character of soil to m depth of feet: Sand E] Gravel F] ~ n6y Loam [:] Clay Loom [] Clay F] A6o6 n E]Nk <br /> Previous Application Made: Yes E] No Construction: Yes <br /> . <br /> TYPE OF INSTALLATION AND SPECIFICATIONS <br /> (No septic tank or cesspool permitted R pu6Uovewer is available within 200 feet.) ' La <br /> � <br /> ld <br /> th <br /> / - "�/ <br /> Disposal Field: <br /> Distance from nearest L.�r��--D�,+on�e from foundation -.-D��fonce �o nearest |n� lin �/�� . « � <br /> ---°� ' - <br /> /ypn c* f ..���Akj�oupm of mh,r mvu+rioL._ -Jota| length'-_.'_�.���----'_.. <br /> ^ -*�' ' <br /> Seepage Pit; Didnn-�" ." nearest well from fuun�otinn--------------------Distance tu nearest ]of line <br /> Numb-or ofpits-----------------------Lining material -_-._------Sbo: Diameter _---_--Depth----_-_'-_ <br /> ! : Distance from nearest well '-�'-�'Distance from foundation'-'''-'''Lining muteriaL--''__.'--'_---_ <br /> E] Size: Diameter-------------------------------------- ----------------------------------------------------Liquid Capacity---------------------------gals. <br /> Privy Distance from nearest well '�-_���'''-�'--'�''--Distance from nearest building-------------- ------------------------- <br /> Distance to nearest |o+ |inv` <br /> - ---------'---'- --------'-'-----''`-r`'---------' <br /> Remodelingand/or repairing (deoribe):---------------- -----------------------------------------------------------------------------------------------------------------------------____ <br /> | ---'--'---------'---'---'----'---------------------------------------'---'---' <br /> � ._-_.__'L-__.---.__-___._..__.-__---______________.___._______._____..__..___._______.. <br /> '--''-''--------'--''---'----''---'------------''-------'-------------------'—'--^r <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> , . --- - -~ ---_. Health_ District. <br /> ��n --.8 ���)�� .-� -.�-------_--_--.--�_----._'(Oeno, and/or <br /> . By:------------------------------------------------------ ------------- --------------------------------------------------------------- -~/--_---..__-___-.__--.. <br /> ' �� ��. showing �� � k� ��� � ��m � m�o � �e|b bmUd��� �� �n 6o c��� um ��e ��e� <br /> [ ` '-� .~. . . .- ' <br /> ` <br /> ' <br /> APPLICATION ACCEPTED DY--------------------- --- ._(leF---..---_--_------_. DATE.- A. <br /> --_.. <br /> REVIEWEDBT------------------------------------------------------------------------------------------------------------------------------- DATE-'''---.----- <br /> BUILDING PERMIT ISSUED-------------- ----------------------- --------------------------------------------------------------- DATE-------------------- <br /> Alterations and/o <br /> ___-_-AKo,ufionvonJ/or <br /> � ,eo*mmonJotiono;_--_----.-----------------------_------.-.-------.------.---.--_---' <br /> ._--_---_-__--_-----_--_-_-_--_--_--_--.-__----__-.-____-_.__.-_-__.-----_-- <br /> '—'-----'--------'----------------'--'---------------�-'---------'--'----- <br /> . _-'-_-'-_---'__.''-'-'''__.''--'-''''-'','�-'''--''---'--_''-_-''-''-----'-_--''_-'_--'----''''- <br /> � .-___--._-_.__-. _-- -'_/.-----------_-_/-~/--/--._~�_'-� <br /> __--..__-------.-.-_---_-' <br /> FIN/ L INSPECTION BY:--- -`-~ - ---------- Du�� -._-- <br /> SAN`JOAQU|NLCCALHEALTHU|STNCT . <br /> / <br /> ` /30 south America" street 300 West Oak Street mc Sycamore Streef ow North "C" Street <br /> i <br /> Stockton, California Lodi California Manteca, California Tracy, California <br /> ` <br /> ES-9-2M 8'5/ nv./""d vv-2/00 <br /> ` <br />