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FOR OFFICE USE. <br /> ^ ~ ~~- � <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> � <br /> o �� � <br /> ^--m''a-- Duplicate)— Dmfw IssuedApplication is hereby <br /> � <br /> mm6a to the Son Joaquin Local Health District for permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance�,lo. 549. 1JOB ADDRESS <br /> �N� <br /> Owner's Name__ ~. <br /> _-_------------_..... -_--_-------.----.....-.----_.-'.-------'--_----_-'--' . <br /> Contractor's Nome x��y3����� Phonm ' / <br /> ---'~~�~*�`--' ------------------'---------'-'--'' '--'-'--''- ---- .i <br /> Installation will serve: Residence rtmenfHouse [] 'Commercial 0 Trailer Court 0 Motel [j Other El <br /> � ^� '.c� �� ^ <br /> Number *f |i�ng units: '.c- Number of bedrooms '_�.. Number of baths -. Lot size ' ----------°�i_---___....... <br /> -' ' <br /> Water Supply. Public system 0r-Community system [] Private [] Depth to Water Table A00129ft. � <br /> Character of sail to w depth of 3 feet: Sand [] Gravel [] Sandy Loam [|my Loam [] Clay [] AdobePik~~lAmrdpwn [] � <br /> Previous Application Made. (If yes,date--------------------> No n4~'New Construction: Yes Fq~~Ro [] FHA/VA. Yes Rg- No [] <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank orcesspool permitted ifpublic sewer ioavailable within 2Q0fewf) <br /> S°ptic Tank: Distance fromx��� 1�� <br /> no~^� No. nfcompm�mon�- �/-----.S|ze."���= �'--Liqui6 6 h ^�1i �-.-.(�upuo/+y- .-. . <br /> Di,9o,m| Field: Distance f U !--' { foundation ^��� ' '�r-/ | <br /> nw°~ <br /> Number _�' ���� ^ � <br /> Typo of filter mu+odoi�� o� of filter mote�aL-,�����-.Jofu| length �--'_' 1 <br /> - ' <br /> ' Distance to Dito <br /> '� �n�r � �� � __Lining materiaL Size: Diameter-- _Depth_ _-_- ! <br /> Cooqpon: Distance from nearest woL-_---Db+unoe from foundation--------------------Lining mo+nriaL---_--''''''.- <br /> [] Size: Diameter-------------------------------------- -__''''''-__-''''-_.--''Liqu|6 Capacity---------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nn*nat building-- ---------------------------------- <br /> n <br /> ._____--_-[] Distance *znearest lot line ------- <br /> Remodeling and/or repairing (deoo,6v):--------- _. --------- <br /> ----------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------- ---'---------'- <br /> ---'-------------'''''---''—'--'------------------'-------------'----'---------'----'' <br /> —'---'--'----'-------''---'---------------'-----------'----'-'-'-'—''---'--------- <br /> red this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and reg ations of the San Joaquin Local Health District. <br /> r'=t pa" ""o='"g =`e of o` location of "y"""`" in ""'""'o" to � <br /> --------- <br /> BUILDINGFOR DEPARTMENT USE ONLY <br /> PERMIT ISSUED---------------------------------- __ -, DATE <br /> Alteration) aqd,yor-recommendations:------- <br /> FINAL INSPECTIONBY� ..�i-����7�=���----. Date-- ���'���,.�-----'----__. <br /> SAN JOAQ0NLOCAL HEALTH DISTRICT <br /> 130 South American Street onnWest Oak Street 124 Sycamore Street umuWest v1hStreet <br /> Stockton,California Lodi,California m""te"".c"o*""/" Tracy,California <br /> ZS REVISED 8-59 nu "'°. ATLAS � <br />