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APPLICATION FOR SANITATION PERMIT Permit No ......l.----_�� <br /> �umo�� � Omo�a�\ / <br /> ` -'�- Duplicate) '] Date Issued - <br /> � � <br /> , `' .~ - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> nd install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS ��D LO ATION,�&----tl�, ---- -2- A�:_Zl ----------- <br /> Owner's Name--- <br /> . Con*ac+o/s Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone_--.—_--__ <br /> |nstallation will serve: Residence [] Apartment House [] Commercial E] Trailer Court [:] Motel U' Other E] <br /> Number ofliving units: /-- Number ofbedrooms �Z' Number of baths j-.. Lot size _-1^2-La -------------------------- ----------- <br /> ��� <br /> Wafer Supply: Public system [l Community system [] Privo Depth to Water Tu6}o ~^ °^ ... <br /> Character of soil to a depth of feef: Sand E] Gravel E] Sovcly [oom 2'-C|oy Loom D Clay El Adobe [I Hardpan 0 <br /> Previous Application Made: Yon E] No New Construction: Ye')� No E] FHA/VA. Yes [] No <br /> TYPE OF INSTALLATION AND SPEC|F|(:�AT|ONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 300f /» <br /> Se k� Distance from n�u,usf well-1-0.*.-'D|,t� f f 6 ion. -.-_M [aL <br /> � �o. of comp��mvn+,�� .------ ..����..��_Liquid dn�h-��'------Copoc-i�' �� <br /> /--------. <br /> f well-- <br /> Disposal Field: \ <br /> ' <br /> from f"un6 ------ <br /> Number <br /> �l~�~ N 6a of lines---------- Length of each k <br /> Type of fi�ter rrateri� Depth of filter mafer�al--- ------------------ <br /> Soepoga Pit Distance to nearest well -- --- ----` Di -t- .,Distance to nearest lot line- <br /> Number <br /> Num6or of pits-.- -..----Lining muforio| zv: Diameter---33------------Dopth- �;7_6r_2_1�-_---- L` <br /> Cespoo|: Distance from nearest well ---.--Distance from fpuhlotion--------------------Lining moh:rioL-_--.---_.,.-'_ ~/ <br /> [] S�ze: Diameter'------''''-''-Depth --''''--''---'''-'''-''Uqu;d Capacity----------------------------gals. ' <br /> Privy: Distance from nearest well Distance from rest 60Win <br /> ' "="=~="y and/or ',p""'"y r°,°°''",/---'------'--- <br /> ._._._____--'_._-___.----.__.__--__--_-_---.--._--_-__-_-_--_'_-_---. <br /> -- <br /> �--------------'-----------­------- -------------'------'------------'------'''-----------------------------------------'------------------------'����----------------'------------------------------------ � <br /> ----------------'------_____-------_------'__��'_----__------'__------_------'-----------------_-------_------'_-----_------'__------___---------__------'-------------__-----__��_� <br /> | 6� a� �� � w� � � 6'� � a��m�� w� �n ��� �� <br /> o,6inance5. State |a°o. and ,u|oo and regulations of the San Joaquin Local Hoa|H, District. K� <br /> (Signed)----------- ------- ---Z��v--------------- -------------------------------------------------------------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------Oit|eL---_--.--------------_.- <br /> (Plotolan. »howYngyizeof |ot |ocmtimn mfsystem Ynrelation +mwells, buUdings, et*, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED DY � DATE <br /> _7 ----------------- DATE::::--/- ,-- <br /> A|trmtinnsmnd/*r rero � i �_-�� .-.--_.-----.--_.-----------_----_---.-_---.-___1--­ <br /> -------------------------------------------- <br /> _ ` <br /> ---'----'-'---'-------- -------' --'---'- ------- '' ' <br /> ---. 4�. .�---�{�z^ync�-.��m-.a���/r'-���.-./��z�..,�r��.�-' ' <br /> -_—.. .~_--_._-_--__-----.--_----'-_.__-_--._-.__---___-------.--'__.- <br /> -''--'-''_`��--'-''--'''-''''- -_-'-'-''--'''-'-'-'''-''-''--''-''--''----~'--' <br /> FIN/\L INSPECTION BY-- ----------- <br /> -.- [ -------------------- Date---/���' ..l .--�� . -----.-------------- <br /> ' <br /> ` H U ` <br /> - SAN JOAQUiN LOCAL HEALTH DISTRICT <br /> oo South American Street 300 West Oak ytr°"+ oz Sycamore Street ow North ^o^ s*w° <br /> Stockton, California Lod|, California w""te"°, California nnov, California <br /> ex-9-2m Revu°a 1.57r.pzo <br /> , . <br />