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~^ ~'- ' <br /> � <br /> APPLICATION FOR SANITATION PERMIT Permit No. -�~�.�.__ <br /> (Complete in-Duplicate) Do+a |s,uo6 7 <br /> App|icmtion is kem6v made to the Son Joaquin Local Health District for o permit toconstruct and install the work herein described. <br /> This application is made in compliance h=ounty Ordinance No. 549. <br /> JOB ADDRESS AND OC <br /> -------------------- <br /> |nstaUmMwn will serve: Residence m�~��pu,+m�n+ House �� Commercial �] Trailer Court [� ��oto| E] C)fke, [� <br /> �-- �� �� ���� � <br /> Nun�6orof \|v�ng uni+c -�- Number ofbedrooms -��. Number of 6u+ho �_7. Lot size -~°..�u�+.="=---_-------. <br /> Yfahvr Supply: Public system mmunity system n Private [] Depth to Water Table 4 <br /> Character of soil to a depth of 0»of: Sand L] Gravel C] Sandy Loam Clay Loam El Clay El Adobe El Hardpan <br /> Previous Application Mm6w; Yes R No Q�- New Construction: Yes E] No Up- FHA/VA. Yoo [:1 NoKj~— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank mr"cessp*o| permitted |fpu6Uosewer ls available within 200fem+J <br /> k Distance from nuon,`t wnU_-----.D|dnnco from foundation-------��ot,riaL-----------.`---- <br /> No. of compartments---------Size----------.--Liquid �ep+h------_--Capacity----_---. <br /> 4epfi/can <br /> � Didnnoo �om nearest well -----Di�onow from foundation------Di�nnce to nearest lot line <br /> ' Number oflines '-''----''-�''Length ofeach line------------------------------Width n[ french'--''''-''-'-'- <br /> � <br /> Type of filter material� D�p+ of filter mu+o�uL--'_�_ length ngfh-_'-_-_-__-- <br /> . <br /> SDistance to res w�|~---�~ Distance to nearest | 10 <br /> Privy: Distance from nearest well------------------- -----------------------------Distance from nearest building--------------------------------------14 <br /> � ^°"'"""""y and/or '~r^^^rg <br /> - r----'------ ~ � --'"-°�---~ ^' - - - ^ <br /> _'---.. - T\ <br /> ' 77-7 --- --------- <br /> | <br /> I hereby certify at I have prepared this application and that the work will be done in accordance-with San Joaquin County <br /> ----------------- <br /> (Signed) ��w°�---------------------------------- a --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> and, <br /> = <br /> regulations off +Thn Sian Joaquin Local Health District. <br /> r Contractor) <br /> / <br /> . (Title)- <br /> (Plot <br /> . <br /> �� p� �n�^ m� � *� in relation to wells, buildings, etc., can be p ace on reve se side).FOR DEPARTMENT USE ONLY | <br /> ) <br /> APPLICATION ACCEPTED '�-----'-'-�--�--'-'''-----''-_-_-''--'_''''- DATE- <br /> ----' ""'EREY|EVED BY ------------'---- <br /> 0U|LD|NGPERM|T |SSUED.__._-------_-----_-_-__-__-.------_ �i <br /> ux/�-.����--__-.____.___ <br /> Alterm+|mnu and/or recommendations:----_'-----------.___-.--_-_.____--__._____._ _____________-_- <br /> . <br /> --_---_-__-_-_--._----------_--_'_.--_----__--'_---_-_---_--- _ ._--_- <br /> �''-''_--_-''--'-_'--'-�--'''''-'_-''---'-'-'''''-'-'-_-''---''-'---'-''--_-''__.''---''---_-- <br /> __-__---_--_--__-__-_-.-'_---_--_-__-._---_---_--_-'_-_------__,-_- <br /> .. <br /> | <br /> -'''''-'''-'---''_-'-'-''''''�-�--_�'�''--''-''''-'''''-_'''---'--''''_''-~_' <br /> ''�^-/'-''-'-------------------------- <br /> �'--'' <br /> --7-- <br /> -'---------------- <br /> FINAL <br /> +--- <br /> ' <br /> FIN \L INSPECTION BY:''' 7 ' -'-' on�' 1601. ' _ <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> /m South American Street 300 West Oak Street /32 Sycamore street 814 North "C" Street � <br /> St" H"". California Lodi California Manteca. California Tracy, California / <br /> ~� <br /> ES-1-2m -n°"a°u 1'57 p.P.nz <br /> ' _ _ - <br />