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Permit No, <br /> ------ ---- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> I-- <br /> Date.Issued ,-j. <br /> Ap lic tion is hereby maJe,to the San Joaquin oval Health District for a permit to con u n�41-inj I e work in described. <br /> p t-a <br /> This ap lication is made incompliance with Cou ty Ordinance No. 549. <br /> - ------- ----------- ------- --- --------- ------------------------ <br /> JOB A,tion <br /> AN'E5,LP-C T 1. J. - -- ---- <br /> Owner <br /> Addre - - ------ ---- ---- -----------—---------------------------------------------------------------------- ------------------------------------- <br /> Contractor's Name._.__----_------------- - <br /> - ----- ------------------------------------------- Phone--- <br /> Installation will serve- Residence X—A partment Hous i Commercial Ej Trailer Coug 0 el 0 Other E] <br /> NuAer of living units: Number of edroorr s -/—/- Number of baths _/----- Lot'Size-E--e-� ------- <br /> Water Suplly: Public sys mmunit system Priva t Depth to Wafer Tool ft. f. <br /> Wj <br /> 'e e��_ <br /> Character if soil to a depth W3eeto Sand g] Grav I E] Sandy E] Clay Loam El Clay El Adobe a[dpan Ej <br /> Previous A licafion Made: Yes E] No New Co [strucf ion- Yes ❑ N <br /> TYPE OF STALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publics wer is available within 200 feet.) <br /> +]a Tan Distance from nearest well ---------------- Distance from foundation--------------------Material---------------- -------------------------------- <br /> No. of compartments---------1---------------LS----------------------------------- Uid-elep----- --------------------- --------- <br /> Dispa Fi Id- Distance from nearest well ----------------Disfance from foundation------------------- Distance to nearest lot line <br /> --------------- <br /> Number of lines---.--. ----------------Lendfhll�of pabh -------------------Width of french - -------------- <br /> Type of filter mater' I__----- lvp.4,of ifllr�la;erial-----------------------Total lengfh�==.v------------------ <br /> S e Disfaniq to nearest well 'stance fora foundation-----/ ...___.Distance to nea est lot line---------- ------- <br /> W pt <br /> of pits_____.._)-------- n ng m erial A���.Size: Di/ameter----04Vi�F...........D pfh------- d-?------------ <br /> Number ol <br /> wCs <br /> Distance from near --------------- istance from foundation------------- U in m /erial----------- --------------------- <br /> Size: Diameter- ----------- <br /> ---------------------Depth--------------- ----------------------------Li d - apacity----------------------------gals.y <br /> �> ---------- <br /> Privy: fance f nearest well------------------ --------- --------------------Disfance,from nEol's ilding-----7-------------------- <br /> Eltan o nearest lo lin --------------------------- --------------------------------- I-------------------------------- ------------------r----- -- <br /> Remodel and/or rep ing (describe).-Il --- -----n: ---14 <br /> I; __!---------------------------------------------- <br /> --------------- --------------------------------------- ------- ------------------------------------------------------Z------ ----------------- -------- -------------- <br /> --------------------------- .......---------------- -------------- --------!�------------- ------- ----- <br /> ----------------------------------------- <br /> --------:;.I--------------------- % ..,;, Ji <br /> I hefe6y certify thaill hav6 P 'thi app cation and that the wei, will 6e'done-'in accordance with San Joaquin County <br /> repare <br /> vordinanc' SQf I —"d ruli"n&`re lat ns. the San Joaquin Lal Health District. <br /> s&,,!I! e a,_ <br /> -------- -and/or Contractor1. ) <br /> (Si - - ----- -------- ------------------------ ----- (Owner <br /> ------------------------ ------ --- ------- <br /> ..9ned). .......... --- ---- <br /> By:----------------------- ---- - ------- - --------- <br /> ------------- ------------------------------ <br /> ti, f- relation,+o'welli-,'16, t4 ja ed on feversels, e). <br /> S, <br /> (Plot Plar'l. showing size of lot,(16ta uildlingtets� �be+ ee e-, <br /> EPARTMENT USE ONLY' <br /> APPLICATION ACCEPTED BY------ t-------------- ------------------------ - ­- - ­ ------------------------- DATE_-------------------7_ ------------- <br /> REVIEWEDBY----------------- ------------------- --------- ------- ------------------------- -------------------------------------- DATE-------------------- -------- - ----- ---- -•------ <br /> BUILDING <br /> ------- <br /> BUILDINGPERMIT ISSUED-------------- ---- --- ----- ----------------------------------- ---------------------------------- DATE----------------•------------------------- ------------------ <br /> I f <br /> Alterationsand/or recommendations:- ---------- ---------------------------- --------------------------------------------------------------------------------------------- ----------------- <br /> ------------- ----- -­:­- ­­ - <br /> ----------------------- --------- --------------- ---------- -- ' -- <br /> ------- <br /> ------------ -- -------------------------I------- -- ------------------- ----------------------------------------------- ---------------------------------------------- <br /> ­ ----------- --------------- - ----------------- <br /> ----------- <br /> -------------- ------------ ----- .. -------------- -- -------------------------------------------------------------------------------------------- <br /> ` <br /> --------------------------------- __----------------------- ---------------- <br /> -- ------------------------0---••-------•---------,---------- ------ -------------------------------------------------------- -------­----------------------------- ------------------------------------ <br /> FINAL INSPECTION BY: ------r-�------------- _C/A------- Date--------------11------ ----------------------------------- <br /> VSAN JOAQUIN'10CAL HEALTH DISTRICT <br /> 130 South American StreefNth 300 1O <br /> .1+ 0,sk Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lo ACa rnia k <br /> Tr <br /> if Manteca, California acy,,Califoria <br /> x,I <br /> ES-9-2M 10-52 Revised W-2100 <br />