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� <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in <br /> Application is �� <br /> hereby made to the Son Jooqulo Local Health District � o permit to construct and /no^aU the work herein described. <br /> This application i: mo6; in compliance with County Ordinance N <br /> JOB ADDRESS AND LOCATION-------OL/_aL] �._ &J�}1��l-- ea---------------------------- <br /> Owner's Name------------l�.a�'li�f�..��.]l�����-��l�J----l--�U.----------------------------- ------------------------------------ Phone--]/��.���I---.. <br /> Address----------2i ...... ------�Uali�.^_____________________________.__� <br /> Contractor's Name------- <br /> z_L11zza- uLi�����-{|D^---_-�------�--.------.. Phono.--'�. .-'_- <br /> |ns6oUmfion will serve. Residence K7 Apartment House Commercial E] Trailer Court El Wotef El Other El <br /> Number of living units: -E] Number of bedrooms Number of baths E�z Lot size-----Q5 -4- <br /> .-._-_-_._-' <br /> VVuto, Supply: Public system [] Community system E] P,i"u|u E][ <br /> Character of mmU to a depth of foot: Sand E] Gravel E] Sandy Loam 0 Clay Loam E] Clay E] Adobe [K] Hardpan [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool po,m|#a6 if public sewer is available within 200 feet.) <br /> ` � <br /> Septic Tank: Distance from nearest woU----!�[}---D|�nncefrom [uundu600..I{�,---------Material .--Ilzal-1-m-ad-------- <br />� Cuspool: Distance from U from foundation Lining material <br /> �] Sizo: Diameter -_-�_��-------------------Depth ------------------------__-.. � <br /> P6vy Distance fro || Distance from building <br /> ' El Distance to neareslot line '---'''''---''--''''-' <br /> ^ 3eopuge Pit: Distance to nearest well----------------------Distance from founduUoo-----_-Distancoto <br /> ' [] Number '� p�. Lining mota�u� J��� Diameter--___. De��------------------------------I <br /> ------ --'---'' --- '�-�-'----'D�po�| Rv�: Didanco6vm noon�tv�L---'-'-D�+ noo �nm f"undn�on'''-'�-'�Di�nnceto noor�t |ot |�a'-__'_ <br /> Num6or of |ines----------------------------------Length of each kno------------------------------Width oftrench__.-_-._--.- <br /> Typo of filter material-------------------------Depth of filter muteria|����'� -------- <br /> Remo6e|ing and/or repairing (describe):----___-.-__-------_-____-._-.-__-.--_---___-.'____-_--- <br />! ._-.---~_--_'--_-'-_'--_-'-_----_.-_-__-.__--__-.--_--._--'__-----_'-_'__----'-__'__----_- <br /> '----------'-----'--'--'--------�-'---'------------''----'--------­;-''--'-'-------- U <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S+o+o |u*m. and ,u|oa and' regulations of the Son Joaquin Local Hou|H, District. <br /> ' �IL"alaD. " -------.-----'-_---..}Ownor and/or <br /> / 8v,-_-_.������4=� �' ---���-�����---------------------.(Tit|e)-----.-2 'I-r2 I------ --------.. <br /> (Plot plans, showing size nflot, location ofsystem |nrelation tuwells, buildings, oto, must be filed wifh this application). <br /> FOR DEPARTMENT USE ONLY <br /> rz. <br /> � <br /> APPLICATION.~'..~., ' .~~^. .^~ .. DATE_- --_.. '_- <br /> REV|EVyB} DATE.- *» '��� -----''-''-_---- <br /> 8U|LD|N�� DATE_..J��*��..��.��..��^��--_._ <br /> ----------- <br /> Alterationsand/or recommendations:---------- ------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------_.---.__--------.-_-.-_--'_.---____-_._-__--_---._---. <br /> -_-'-_.-_-''''--'-_-''''-__-_.--'-'_-''''-_'�'-'-'---''------'--.-'-_''''__.--__''-''''''-' --------- <br /> ---------------------------------------------------- <br /> '-_ <br /> ---------'--'-------'-------------'---'---'-'-----'—'-'----'--------'--' <br /> ' -'-_'�--''-''''_-''_'-'-'--''-'--'''----'''�-��_'���-'�''--_-'''--'''-_'''-''-'-''-''''-''---'-' <br /> ! ' <br /> PERMIT No-.�L-10----------- |S3UED..a,.t�_j_7-|q,°=�Z)-_(Do+e) FINAL INSPECTION BY:........ --------------------------- <br /> . Date----------------------------------- ------ ------ ------------------------------ <br /> SAN JOAQNNLOCAL HEALTH DISTRICT <br /> 130 South American Stm,wt <br /> Stnmk+on, California <br /> Es-9-2w v'so vv'/asv | <br /> mA � <br />