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APPLICATION FOR SANITATION PERMIT Permit N <br /> (Complete in Duplicate) Date lemo6 <br /> Application is hema6v mu6o to the Son Joaquin Local Health District for u permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> --- ADDRESS— ' - -- - ��-� '-~�'----'-~------'-----'-'---------------------'''------'' -�} '��' <br /> Owner's N ----------.-------.. Phone-._��.�i."��.�,-'l.. <br /> Installation will serve: Residence X1, Apartment House E] Commercial F] Trailer Court Ej Motel E] Other E] <br /> Number of living unifs: _1---- Number of bedrooms Number of baths I--- Lot size --- ,__/__/)__----------- <br /> Wafer Supply: Public system V Community system F] Private F-1 Depth to Water Table ;�ft. <br /> Character of vmU to a depth of feet: Sand E] Gravel F] 5um6y Loam El Clay Loam E] Clay [] Adobe E] Hardpan [] <br /> Previous Application Made; Yes [] No [:] New Construction. Yo, n No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> m <br /> septic tank or m000poo| permitted if public sewer isavailable within 200 feet.) <br /> Distance from oco,asf well----------------- from foundation--------------------Material --------------------- <br /> 'I No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- � m« <br /> O 6:. Distance from nearestwoL-----Distance from foundation--------------------Didanco toneuna� lot line.._--- <br /> ��~���� ;- ,�' Number of Una,------'---'�-__Leno+ of each |inr`-__�'''''-�Width of +�nc6---''_---''--'_- <br /> � - <br /> Type of mo+e6oL'' ----Depth of filter material-----------------------Total length------------------------------------------ <br /> �- , <br /> Seepage Pit: Distance to nearest ---Distance fn,m foundation.-i-&----' Distance to nearestA--- <br /> �� Num6aruf �Us-/----�L|ning mo+e6v| ���-���� Diomn�ac -���^.����Dmp+�-�-S-11--- _-. <br /> Cesspool: Di0unce from nearest well '----''Distance from foundation �—��---Uning material -----'''_-'--__ <br /> [l Size: Diameter._-__--_-._-Depth----------------------------------------------------Liquid Capacity---------------------------- <br /> Privy; Distance from nearest we|L_-''---'''-----_'''Distonos from nearest building '-------_'__----_ <br /> [l Distance tonearest lot line-----------------------------------------------------------_..__-__--___.—_'_.._--_-_-_--.. <br /> Romo6o|ing and/or repairing (describe)----'''_--_'''___'----'--__.'-__-__''-____--_--.____-._---_____'_ <br /> ._ _-__-----'------_----_'_----.--------_----___-------_---.------.-------' <br /> ----------------------__-._---_'-..--..----------'----------_---_----'`_-------_----------__'_-----__' <br /> I hereby certify that I ha prepared fh' ap Ii. a on and fka+ the work will be done in accordance with San Joaquin County <br /> aw of the San Toquin Local Health District. <br /> (Plot p I s owing size of lot, location of in relation to wells, buildings. etc., can be aced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y --------------.-�--��--_------. D/\TE <br /> RGY|E\�ED BY_-_-__-__-.-��6�--------._------_-.__.--__-.. DATE ' <br /> 8U|LD|N�� PERMIT ISSUED_-'-_--'-_--'---'--'-''_-_--_''-_-''-'''''-' DATE'''--���--i''--_-'''-_--_.__ <br /> Alter*+ions and/or rocommenJa+ions:_---------------------------------- ------------------------------------- ---------------------------------------------------------------------------- <br /> ----------------------------------------------------------------_.'''--''''--''''-_'''-__-''-_--''''-_---''__.'_-.'''-__.''-__''_____ <br /> ---'------------------_--------''----------'-----------'���������-------------- --------------------- ---------------------- -------------'------------'-------------'--------------------'---- <br /> -----------'--------------'`-------````---------``-------````-----```��--'---``---------`-------------``------'`````---------`---`-----```---------```��'```-----``--------------' <br /> �-------'��--------------- ---------------- ---'----------'----------------------------------------------------------------------------------- ------- <br /> FINAL INSPECTION BY:------------- �r -------------- Date'�-~��'-�./~�� <br /> SANJOAQ0NLO'CALHE4LTHD|STRkCT <br /> /xo s""tk American e,"°+ oonWamOak str°.w |xx Sycamore Street 8/4 w"*h ^cr' s*=* <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />