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APPLICATION FOR SANITATION PERMIT Permit No. <br /> � <br /> (Complete ;n --'--` <br /> Dm+a Issued - 7 <br /> ' <br /> Applica-1-ion is hereby made to the San Joaquin Local <br /> Health District for o permit to construct and |not:U the work herein described. <br /> Tho. S49. 7 <br /> / / ' . . . <br /> --JOB z���- /DRESS /\NDL(�C�T|<�N-. 5@-South.._����s�te. East ._-_ <br /> Art Korook DBA Western Lumber Sales <br /> Owner's Name------- -- --- - ------ ------------------------------------------------------------------------------ ------- -------------------------------- Phone------4!!�2.2------------- <br /> Address----------------P~{y.r...Box-���-------.-.-------------------- -------------------------------------------------------------------------------- <br /> Contractor's Name---- �-------- Phone----------------------------------- <br /> Installation will <br /> -_-_-' -_|nstallationvill serve: Residence E] Apartment House Ej Commercial Trailer Court E] Motel E] Other E]xc <br /> �� <br /> Number nf living units: -------- Number of bedrooms -------- Number of baths -.�� Lot size --.-^��-A3QrMkWi--------------------------- <br /> Vva+nr Supply: Public system [:1 Community system El Private M Depth to Water Table -------- ft. <br /> Character of s6| to a depth of feet: Sand [] Gravel [] Sandy Loam El Clay Loam IX Clay El Adobe El Hardpan [] <br /> �� � ' <br /> Pna"iovo Application Made: Yes E] No cr New C�nsfrucfion:' Yos-_ -���� No El <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank orcesspool permitted if publfcsewer is a"ol|a6|ewit hin 200 feet.) <br /> Septic Tu k' Distance from noorn`f w6|-��-------Distance*, f foundation .. -------- <br /> No. <br /> ~ <br /> \� <br /> of �o�pv,+muoi:�����-���-_-..S|zu.�������---.--Liqui6 �op+k-.--������.-�(�apo�+y--����.o�-- , <br /> / ^ <br /> Disposal Field: Distance from nearest weU�,',2j0'''Disfunce from foundation <br /> 4�9_^ Number of |ine�_.�A.---._---.Length of each line..— � <br /> . Q..� ��- -YV <br /> � . |dHh of �un6n---�4z�c------. <br /> ` Type of G|/e, maiorial- ���' H, of'fi|fe, motehaL-]L-Ft--Jotm| length'''IaQ__F_t-.'--'_-~ <br /> Soepage Pit: Distance to nauned well-__-_-Distanco from foundation--------------------Distance to nearest lot line-------------T**4 V <br /> E] Number of pits----------------------Lining mofv,iaL---------------- Size: Diameter-------------- --------Depth--------------------------------- <br /> Cesspool: <br /> _�----__--..Ce q,00 : Distance from nearest well ''--'_-Distance from foundation------ --- ---- -- Lining rn^terin!'-'-''-'-_'--_- -J <br /> [] Size: Diameter-------------- -----------------------Depth----------------------------------------------------Uqui6 Capacity.-_-_--_guIs. � <br /> - , <br /> Privy: Distance from nvn�` well ����--�'--'-''Distunco from nearest 6m�6�g '-----'''__.-'---,_� <br /> [] Distance h, nearest lot |ino--------------------------------------------- -------------------------- -------------------------------------__--_-- <br /> RomoJeUng on6/cv repairing (describe):'_' ''�-'�-'''--''-_--__.-_.-------'-'_-'''-''-'''-__--__-'-' <br /> __ ------------------------------- _ /� _�. ��g�..�%���� __. _ ________. _. _ - <br /> ----------------- <br /> ordinances, State law , and rules and re ations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 8U|LD|NE; PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------------------------- _ <br /> AKo,aGonoun6/o, rncommen6ations:----------.---._--.---------_----------------------_--.----. <br /> .--_-.—_--_----_-._------------_._--.__-_--_---_-_---'_---_--_____-_-- <br /> '-'--''--''''-----'''--''-'''''—''--'---''--''--'''-'''-''''-'''--''---'-----'--''--'------ <br /> __---___________________________________________'___________________________________________ <br /> _________�_�__ -----_______________________________________________________________________ <br /> RN/\L INSPECTION 8Y----- ------L'--------'----------------------------------------- Dmte-- -----------------------------------------::�.4---- _._-' <br /> 5AN JOAQUIN LOCAL HEALTH DISTRICT <br /> /30 S""6 4m"a"°" Street xon West Oak Street /32 Sycamore Street 614 North ^C' Street <br /> m"ckt"". California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M novaaa W-z/oo <br />