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N` <br /> APPLICATION FOR SANITATIONPERMIT; rn � o <br /> in Duplicate) Date Issued / <br /> /` . <br /> ' Health District|t6 Di� i t fnr u <br /> permit to construct and install the work 6o,am 6omdescribed.Aon||cu+|on is hereby made h, the San Joaquin Local <br /> � ~~- --�- � <br /> This application is made in compliance with County Ordinance <br /> - ' � <br /> ' �------------f���' <br /> ° <br /> Installation will serve- Residence Apartment House E] Commercial E] Trailer Court El Motel Other <br /> IN pe� <br /> Number of'living units: Number of bedrooms 'Number of baths --I/-- Lot size --------------------- <br /> Water Supply: Public system El Community system El PrivafeXlDep+� to Water Table,��ff. , <br /> ' <br /> Character of soil toa6�� � 3 feet: Sand U GravelU Sandy Loam u ~�, Loam El —Cla' �� - ��� ^Hardpan - <br /> Previous Application Made. Yo, El Nox" <br /> New Construction: Ye^o No E] ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-' (No sep�c'tank or cesspool permitted ifU <br /> pu� c sewer is available with <br /> �8� <br /> - <br /> - __ <br /> � -- - - M <br /> �._. <br /> .;~ ~^- Tank: Distance ��m nna,auf m ..-D� t� J <br /> -Nnfcumpa�men+�- ~ --Size',,�K -quid dnp�h'-z -co <br /> capacity <br /> '- <br /> »� �*�' D�+uncu tro� nomm-� well Distance from foundation Distance to noana� �f |ima.---- <br /> Numbor of lines ` � LungH, -� each line Yi�fk offrench <br /> Typo oFVter moto�nL.--------Deotof �Hor m^+aru| ..� 7otn/ /nngnn ^-_T--.. <br /> � �� <br /> ^ <br /> ---Distan;ce��ro_mfo Seepage Pit: D�s�ance to nearest well---- <br /> ' <br /> Cess p~~'' Distance ' - �ao+k Liquid Capocit�'---._--�om' <br /> ��� ��mafm ___�________ <br /> �� � �'-''-''_�----~.~..'-'''---'' . <br /> � " � D�t ncefrom nearestwvU-.-----_-------Di�"nco 6n= nearest building' Distance fn_nnu�o� |n+ |imu--_-----.-------'__.-_-'--'_ _'__-'��___��____-�____ <br /> ~ � <br /> , ' '--(Sig e K*mu6e�»g un6/«'''n'p^�ng]6»m�ibo��_ . _ �_________ __-�__ ____ _-------------------------------------------------- <br /> ---- ^ ��! i----'''---------'--.__________________.___.____.-________._______________________---' <br /> _''-_.'-_''-'_------_''-'''--'-'--_--_''___-''--,---'-'�.- <br /> 0 mend <br /> ---'--------'----`--'----'' and this application +6 the work *;U be 6 in accordance with San Joaquin County <br /> ordinances State Ajam , an&rules and <br /> � --��tp�n snnwmgmz= °" ",. on of system in relation_- , _ <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------- <br /> ------------- <br /> REVIEWED BY <br /> UED <br /> '- ^ � <br /> , ^ -''-''--_`'~''''-'''-_'-'''-'-'�� <br /> '--''-''-'''''-- -''_ <br /> ~+ <br /> � / ~ ` Du+� -''-'-��-''----'---' <br /> F|N/\L INSPECTION �8Y�----.-��--/�x�/�u���m/_-- -----'_---� <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> ' ono��� Oak e,""� mus'""�"= s�"� m* m"�h ^C^ Street <br /> �v South American o+�� ° n� California <br /> ' s+"**v". California L�di. California ^�*ot°oa. California "v. mo <br /> � <br /> ES-11-2M i . Revised W-2100 <br /> ._' <br />