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\ <br />\ <br />APPLICATION FOR SANITATION PERMIT Permit No ....... ` <br />inDuplicate)��. c) <br />� made ��e�nJ�quin��|Hao�D���f�uponn��c�s��u�|m�Ut�����n����. <br />T6� application is made in compliance with County Ordinance No. 549 <br />JOB ADDRESS AND LOCATION -.2o -o -o -o ----- (5 -�. Z z LA- ... .. .. ..... ------- ..................... <br />- ~ <br />/\dd ------------------------'- - ---'-'--'--' ' <br />Contractor's Name ......... _-�� -���������----.-----.----------_.---_.--' Phone. -X./0- ..�6-17- <br />--- <br />Installation will serve: Residence [] Apartment House [] Commercial [] Trailer Court [] Motel 0 Other [] <br />Number of living units: umber ofbedrooms -------- Number of baths Lot size -------��� �,�_.r==_- <br />Supply:Water 6| ,=~+Community system [] Private Depth to Wafer Table <br />Character of soil to a depth of 3 fe-4: Sand E] Gravel E] Sandy Loam [] Clay Loam E] Clay [] Adobe Z-`Aa*&n C) <br />Previous Application Mad- . - El , NoAjll,�e, Constr'uction: Yes F-1 No E] <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />tic TtnkK,: Distance from nearest well ----------------- Distance from foundation -------------------- Material -------------- --------- ......................... <br />D' osal H Distance from nearest well ----------------- Distance from foundation -------------------- Distance to nearest lot line ................. <br />SZX� Type of filter material ---- A�� ------ Depth of filter material--- Total length ------------------------------------------ <br />SeeZ Pit: Distane!�&rfanclation ............. Distance to nearest lot line--.r-..o ..... <br />Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ---------------------------------------- <br />1] Distance tonearest lot line -------------------------------------------------------------------------------------------------------------------------- -..Remodeling and/or repairing (describe): --- n --- ---- ----------- OQ -1 <br />`\ <br />--------'-------- -------------- <br />I hereby certify that I have prepared application and that the work will be done in accordance with San Joaquin County <br />ordinances, Sta$�-S, and rules and regulations of the San Joaquin Locol:Health District. <br />By: ------------- : ....................................... ------------------------------- P A ---- --- ----------------- <br />(Plot plan. showing size of lot, location of system in reiafi n o weiis, buildijin, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />-~ <br />.BUILDING PERMIT ISSUED---'--�..........................................................^r~-------------------------------------------- <br />Alterations and/o-----__-__.-_ <br />-------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------ .......................................................... <br />--------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br />-------------------------------------------- ------------------------------------------------------------------------ -......... ............... '------'--'-'----'-------'-- <br />RNAL |N3PBCT(JN8Y -_--__- Date. .-~ - -_~z�.----._-_-'_. <br />SAN JOAQU|MLOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street m14 North "C' S**w <br />