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' ^ <br /> , <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> � �n -1i <br /> `~-^�-- --''--'` Date Issued _��i---l------L <br /> Applica+ion is hereby made to f <br /> he San Joaquin Local Health Dist rict for n permit to construct and install the work herein described. <br /> This application � mm�oln'mm��n� �� C�n� O��u�� No. 5�. <br /> ' <br /> ' <br /> Owner's ---------------------. rnvn=..z_* ----. <br /> � ���re��.-���--:� -z��xc����,�_-._---^u��nm��-_--.---_--------_-_-----_--.--_.----_----_---. <br /> _� <br /> ' Cnnt,octor'o -------------------------- -------------------------------------------------------------------------------------------- Phone---_.---.--.--.- <br /> / |^staUation will serve: Residence Apartment House [] Commercial [] Tn^||o, Court E] Motel Ej Other [] <br /> Number ofliving units: 'V----- <br /> ' N�m6nrofbedrooms Number ofbaths 1-.. Lot size _.��0.4­00---------------------------------- <br /> � . <br /> / Water Supply: Public system [] Community system Private W Depth to Water Table ft. � <br /> � <br /> Character of yol| to e depth of 3 feet: Sand [] Gravel [] Sandy Loam ;a Clay Loam [] Clay [] Adobe C] Hardpan [] <br /> | � <br /> Previous Application Made: Yo, 0 No | New Construction: Yes [)5 No E] <br /> ^ <br /> TYPE OF INSTALLATION.AND SPE�|FiCAT|{}N5: <br /> }` (No septic tank or c esspon| parmN+m6 if public xowo, is available within 200 feet.) � <br /> � <br /> Septic <br /> Tank: Distance <br /> from nearest weU 'u^4--Di,+a ] f � � �otivn -��-~. u/ ^ <br /> � puc' <br /> � --.Nn. of � �_ <br /> � - .. . .--. q . � - � � - <br /> ' <br /> Disposal Field: Distance from noon,ot .n|L6.49---------Distance from fou X0-----------Distance to nearest lot line.../Aj------ <br /> Number <br /> Numbe, o{ lines---2 '-''-' Length of each |ime-10 '''_'-YYid+6 of trench-.--- --- ----------------- <br /> Type <br /> '-''- <br /> Tvpe OT filter mutvr�o|_/�»��--���De. . offi|ta, material .I,?'°^---------Total length----/ b!--------------------------- <br /> Seepage <br /> -_-_----Seoouon Pit: Dist n8e to nearest well _,--''--Distance from foundation------------------Distance to nearest lot Unu''--_-- <br /> Num6or of pits----------------------Lining material-------------- Diameter--------_Depth ------ -- ----_--- <br /> : Distance from nearest -'--Distance from foundation'-''''_'Lining muforiaL'--'-''-''-''-_ <br /> 11 Size: Diameter--------------------------------------Depth-------------------------------------------- -------Liquid Capacity---------------------------- <br /> �_ ^ Privv _ Distance from well-;��.-�',,-,'-�--'-.--Distance from nearest building <br /> E] Distance to n*ur*sf |cT |inc-------------------------------------- ---------------------------------------------------------------------- <br /> - ~ <br /> Remodeling and/or repairing /dmv ribe):.-'_--'-'----'-'--'''__'-_-'--'-''-_''''--__---__'.-'___-'---'-- <br /> '-------'''------'—'-'---------------------------''--'------'----'--------'--' <br /> . ---------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- --------_-_------__--_----_-_---___-_--_-----._--_-_-_--_-_-----.. \` <br /> ' application and that the workwill be done in accordance � � San Joaquin County <br /> regulations of the San JoaquinLoca Health District. <br /> ' ���no� ..X��-- -----.----�-.��--_�����----.�---./Ownerand/or Con�aw+*,\ <br /> Bv:......................----.-_----------.--------------------.R7 le)------.-----.-----.----.- `. <br /> /P�t p|an, showing o�a of lot, location of system in relation to *�� 6��ingo, m+�. can be placed on reverse side). <br /> � <br /> | FOR DEPARTMENT USE ONLY <br /> ' <br /> REVIEWED BY--------------------------------- ----------- ----------------------------------------- -------------------------------------- DATE-----.-_-_---._--._--- <br /> BU|LD|NG PERMIT ISSUED------------------------------------------------------ ---------------- -------------------- ---_ DATE---_---.------___.- <br /> / ----_'-_ -''_�.--.'---'''' ' .'---` --''_' -__--� - '^' -- _- _'-'_--__.__-. <br /> ' -` ' ' ' ' <br /> ` .. .. '3��wm. <br /> ---------------.�---------------------------- -^�°==,�. ^ . =^............. . �.. <br /> ` . <br /> RN/\L INSPECTION -----_' Dote-- ------------------------------- ------ ----------------------------- <br /> SAN JOAQU|NLOCAL HEALTH <br /> ' D|STRICT <br /> 130 south American Street 300 West Oak Street 132 Sycamore street 814 North "C" Street <br /> Stockton. California ' Lodi, California wan*wxa, California rmcv California <br /> ,�°^^T..", ,,^° '� <br />