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� <br /> APPLICATION FOR SANITATION PERMIT <br /> ���mu�f� �mDuplicate) - ] <br /> ` ��'��� <br /> Date |=uo6 <br /> ' <br />� is here <br /> by made to the San Joaquin Local Health Dist for u permit to construct and ��oUthe wur herein daxo,6e6. <br /> T�� upp|icotinn <br /> is made in compliance with County Ordinance No. 549. <br /> p /� // ��� <br /> J��B /\DDRESS /\ND LC)(�AT|(]N--. �'=�°".�r /����xL----z------.~����.--���-. ------. ------- <br /> Owner's Name---------------------------------------- ----------------------------------------------------------- hone------ -----''-r'--- <br /> A6J <br /> � otel E] Other E] <br /> Number of living nitsIN �xofbedrooms 'bN 6mof6m1h1 �t size -41 --- <br /> Wafer Supply: Public system E] Community system E] Private X Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam,El Clay Loam El Clay El Adobe 5g Hardpan 0 <br /> Previous Application Made: Yes [_] No K New Construction: Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Ce,p�i� T4nk' Distance from neares'f well-----------------Distance from foundation--------------------Maferial____4�-------------7---------------- <br /> Disposal Field: Distance from nearest well",5a.- Distance from foundation 'P -,-Distance to nearest lot line---:n7:�---k- <br /> Number of lines ---Length of each line---- --.-)----.Width of trench-------- <br /> Seepage Pit: Distance to nearest well-,--------------------Distance from foundation--------------------Distance to nearest lot line---- <br /> [� 3ize: Diameter-------------------------------------- ----------------------------------------------------Liquid Capacity----------------------------go|,. °^ <br /> Privy: Distance from nearest well --.-'-_.'-'__.'''_-''Distance from nearest building-------------�.'___'--.__ <br /> [] Distaocotoneorest lot Gnu--_._----._-----'__-___---_--'-----__--_-._---_--. <br /> Remodeli�ng and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------____-_..__.-_._._---___.____-.___^._ <br /> --'-----'---'------''-----------'```-----------------------------'---'--''-----' <br /> �-_---- __._ - --- ' ____^__ <br /> 1 h reb ce fif that I av prepared this application and that the work will be done in accordance with San Joaquin County <br />, `"°. cea-ate s, and rul s and re' laitions 9X?he San Joaquin Local Health District. <br /> (Signed)--- Ai_ - <br /> Y-er Contractor) <br /> ' <br /> _ / �� e ^/ <br /> � - _ . �M <br /> �~_------------ <br /> (Plot <br /> _-- <br /> /� �n. � �� � m|a� � ~o� b��� ,� �n � �� � �� �� |. <br /> ' ' <br /> FOR DEPARTMENT USE ONLY <br /> ...L~..,~ . .`.... ISSUED---------------------------------------------------------------_-''''-''''''-''- ��-'''-''-''------''' <br /> /Nterw6ons and/or recommendations-------------------------------------------------------------------------------------- -------------------------------------------------------------_---------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------_----- ----------------------------------------------------------- ------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ''--'----'-_--. <br />' ------------------'----'--------'--- ---------------------'----'--------- <br /> x ^ <br /> RNAL INSPECTION BY:---------- /\// ------------------------- �u+o�' `- '''-''---'-'__- <br /> SANJOAQU|NbOCALHEALTH DISTRICT <br /> /nn s""m American Street sm v/"m Oak Street /az Sycamore Street ow North 'xr' Street ' <br /> Stockton. California Loa/, California w""+""°. California Tracy, California <br /> so-9-2w n's| Revised \m'z|no <br />