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APPLICATION FOR SANITATION PERMIT Permit No. <br /> - <br /> ~ r°o' 8x v~�= ~~p~~'e/ dL <br /> Du+o |,o»y6 -/_P�v�� <br /> A Local Health Dist ricf for a permit to construct and install the work herein desc <br /> T�plica4-ion is hereby made to the Son Joaquin <br /> is application is made in compliance with County Ordinance No. S49. <br /> Phone <br /> - '_� ' <br /> � --.''--'''--''� <br /> '�'-'--�'..'"='.-°c'~-~-='=--�-� <br /> ' <br /> w�`.. -.----- phnoe.---.__----_-..Contructora Name--.���?�)�w��-- � �Installation will serve: Residence Other [] <br /> Number of living units: .)-.. Number of bedrooms . � umbrr of baths - - Lor size <br /> Water Supply: Public system E] Community system D Private xDopth to Water Table <br /> (` <br /> � <br /> Character of mxU to m depth of feet: Sand [] Gravel E] Sandy Loum [] Clay Loam [I Clay [] /\Jobex Hardpan [] | <br /> P,a°|nuu Application Made: Yu, 0 No K New Construction: Yes E] Nox ^ <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) \ <br /> �Septicm <br /> fro ���eun,,t well -------�� <br /> Isp s I Field: Distance fr�m nearest well__/404� -Distance from foundation---- -----Distance to nearest lot line------- <br /> Sal <br /> � ..Di,t,nco from foun6ot�o� utn,iu|---------------.- <br /> No. of om � <br /> pun��t -..--- -_ ------- <br /> �S�ze - .-L[qui6 6vp+ ----------- ! <br /> ~~� . c--- ^ <br /> ield.11 <br /> Type of filter -Depth of filter material... --- <br /> Seepage Pit: Distance lo neare'st well----------------------Distance from foundation--------------------Distance to nea est lot line--------- <br /> Size: Diar;eter <br /> Remodeling and/or repairing (describe):--------> 4Z , �__6 je�,- � <br /> .P N------E_4_14 ----- _ ----------- r_�-------- <br /> -------------- ----------------'-----------'---'----'-----------'--------------'----'-'''----'---------' <br /> -----.------'------______---_-.-_._--.----_—_----._-.-,_---_-.------------ <br />" I hereby certify +hat | have preparedthis application and that the v;ork will be done in accordance with San Joaquin County <br /> ordinances, _tate laws, and rules and regil la+*,ons of +he San Joaquin Local Health District. <br /> (Signed)-;----- 11C y-- ----------------------- -- ----- ---- ------ ----------------------------------------- - ----------------------------------------------(Owner and/or Contractor) <br /> �y�' .--���^-i'�w���~�.����*~�s��e��.---------.�//f�)--__----__-__________ - <br /> --(Plot plan. showing size of lot, location of system in |otion to wells, buildings, et* be | 6 on reverse side). <br />! \ <br />' <br /> FOR DEPARTMENT VSbONLY \ <br /> DATE APPLICATION ACCEPTED BY---------- -----------------'-----' ' <br /> u/~/�� <br /> RB1EVVB] BY--------------------------------- '''-^ ' <br /> BUILDING PERMIT |53UED'_----'�-''''— DATE�--'�-'-_..-'-'''`_���.__ <br /> A�o,a�onsmn6/n, rwcommendm�onx:------� -����' .-----.------__-----.-_-------_- <br /> ._-_---._-.------_--_-_----��-_---._--'_-_--_^.------.--.__--_---_--.._-__. <br /> .-_-----'__---'''_''-'—'_''--'''-_-'---'--'''--'''--''''-'-'--''--'--'-'__'''----'--.-'-_'. � <br /> —'---__-''''_''----'-''''-_''--''---^'---'-'''-'''--'--''--'''�-'''--'''---'-''-'-------'- \ <br /> '--_--'---'''--''--''' '-''''--''-''--''---'''--'''_''-'-'-''-'--. <br /> , ~-� --� ---' 5Z, <br /> �N'�L INSPECTION 8Y�---..' Date_-----�---^�~�.---..��.. __— <br /> SAN JOAQUlN LOCAL HEALTH DISTRICT <br /> ^ <br /> 130 South Arnarica" etreet 300 West Oak Street /32 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi,' California Manteca, California Tracy, California <br /> ': <br /> FS-9-2m ,°°°^^,°"O" `,-°, <br />