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wr <br /> APPLICATION FOR SANITATION PERMIT Permit No.,-� P___ <br /> (Complete in Duplicate) Date Issued bk/14- <br /> Ah m� tn the 3u J | L�o H�|� ��6� foru p�m� foc���� mm6 �,�U �n�6 erein described. <br /> T�plicafion is hereby <br /> 's application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LO~' ' p�no------------------------------ <br /> Owner's Name nm -- -- - ' ' �---_-.---_----r- <br /> xoonuss---'__------- . --' <br />' <br /> Contractor's N Phone .. ' <br /> Installation will serve: Residence [A Apartment House [I Commercial El Trailer Court­[] Motel El Other E] <br /> Number of living units: Number of bedrooms Number of batks Z__ Lot size ---IZ- ----------------- <br /> Wafer Supply: Public system Ej Community system El Private 0 Depth to Water Table -,7-- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam K Clay Loam EJ Clay El Adobe I--] Hardpan 0 <br /> Previous Application Made: Yes Ej No JK New Construction: Yes X] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is / m/ rnm 200 nw=,) <br /> Septic Tank: Distance from nearest Distance from /on �� <br />' °".` = A= `~ <br /> No. of compar+mnnt,------. =---Sizo.� xmVX-a-_uq«'o neFvn ��1 ~apa`�', ^ <br /> - <br /> Dnce from ffoundufl| Field: ' || <br /> =�q~~ Number c� lines Length c* each line �� ^- vv/om of trench ' <br /> �- Type o� �|+er mot�riuL ��. DepH` �f �|t�, mnferiuL`',��'---Tofu| |ength .����.�---.---- 1 <br /> ------ <br /> Seepage Pit: Distance to nearest weU..- ........ ---Distance from foundation------------------- Distance to nearest lot line--------------- c^ i <br /> ElNumber of pits '-'''''�—Uning material----------------------- Diameter _—''---Dooth _'— --------------------- <br /> Cesspool: <br /> ----'-'-'Ceepoo|: Distance from nouro, wrL-----Distancn {nzm foundation-------------------Lining material --.------._'El - <br /> Size. DiaDepth Liquid CaPacity. --gals. <br /> .`..'. -_ ~.~...`~ from _nearest -,----------------------------- _- <br /> / El Distance to nearest lot |�e- ---—'-''''---- ----------------------------------------------------------------------------------------------- ---------- <br /> Remodelingand/or repairing (describe)----------------------------------------------------------------------------------------------- -------------------- ------------------------------- <br /> ---------- --'----------------'---''------'-----'''--'----'''--'--''-'------'--'----'-''--' | <br /> ------.----_---------_-------------_--_-__-___.._..___--_-__'_-._-'___----_--- �. . <br /> .--.-_._-._-__-__---.____-.._-----______--._--_'-_-__.-._-._-�---.____--.-- __1--------- <br /> I <br /> ' <br /> have prepared � �� � v� � � 6� � ��a� �� S� J�� C�� <br /> ordinances, State^ �laws,' � and m�s'and regulations of the San Joaquin Local Health District. � <br /> / <br /> ( and/or Contractor)Contractor)G�n�dL. {`^="=' <br /> } uy;-' � _--_________._________r__,______________________ <br /> | (� �n. �� / � � � � �� ��� � *�. ���g� �. �» � �� � reverse side). � <br /> -------------------------- -------- ------- -T--- <br /> -__ wdafions:------------------------ ------------------------_------------------------------ ----------------------------------------------------------------------------- <br /> -_._----.------------..---.--------.- --------------------------------------- ------------------~�~. ---------------------------------------------------------- --------- <br /> _--------------------------------- -------------------------- -------------------------------------------- ---------------------------------------------------------------------------- -------- ---===----' <br /> -------------------- ------------------------------------------------------------------------------------------------------------------------ ------------ ------------------------------------------------------------------ <br /> --'�-'—'-''''''- - --------------------------- '_—'—''--'''''--- _---'''''''__''''-''-_-_-' <br /> F|N/\L INSPECTION 8Y' --'-'--. Date--- lr�y`p--��''____� / ( <br /> SAN JC>AQU(N LOCAL HEALTH DISTRICT � <br /> oo svmm American Street 30D West Oak Street � /32 Sycamore S*w* nw North ^o^ Street <br /> �*�/ California w""�*^ Californiann�v California <br /> ` <br /> Stockton, California , ~="� . . <br /> ES-9-2M 10-52 Povised W-21DO <br /> , <br />