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A.oPi.ICATION FOR SANITATION PERM � v <br /> A+plication is hereby IS b t4 Un Joaquin'LoW Health' for` petmif tom htict and instal the work herein <br /> Th application.isxwu a id cotoliance�with Ordine"N 9. « <br /> JOB ADDRESS AN! ATION...« <br /> • <br /> � »« » <br /> CC fttra�" Nr,cnI.— <br /> wig sews: Residence ❑ Aparhnent House❑' Ca�mweial ❑ T'raaw Court ❑ Other ❑ <br /> -' umber of living units:' Number of bedroom jr Numbw of 46s04so 1a1 <br /> ? Sr i�l. Public system ❑ Community Privati <br /> system ❑ , <br /> a son to a depth of 3 feet: Sand❑� Gravel❑ 6�syrtreerts /�dewe(�'� <br /> F INSTALLATION AND SPECIFICATIO -. 1, <br /> r o <br /> Nat,,,»ptic tank or cesspool permitted if publk srwer 4anralMil:ll�r►Rhita :" '? ` <br /> an�ar° Distance from nearest wsg»._.....,,,,.zDisMnee from <br /> A i1 <br /> No. of compartments. .._.....r.«..,.._.Capecity <br /> Distance from nearest well».,„. ..,�,Distenee frbM' Lining ntaferieL.._.,. <br /> t Size: Diameter._........ ,.;, :. <br /> ! Distance from nearest well._........ � �Disiterroe.fieun oww"d bu"ig......�....... �� <br /> ? /! Distance to nearest lot li <br /> Pit: Distance to nsarree�,w_e_ll../ li` to nearest Iot " <br /> a � Number of its..b.l L„ Lin` ''' <br /> 1,D 4d: Distance from nearest wall...�.:w. .xlDist f D'istVince to nearew -"I , <br /> Number of lines„.„.:............„.,. <br /> Type of filter materiel...„.•,,.a..,,.�,,,,>Depth of <br /> Re ing an ropeiring (describe):... <br /> ry <br /> Y N F �f.ww..•„.„. .„.......„..»..„...„.«.„. „„.-«•„w»w•„.•.w.M•„WtiY.M+•.w.WN„Y.vFwMMMww <br /> 1' (fir eerFify that I haw prepared this apptkafiaw ariei that tiw rrak vrq be dtwe is aeeordewoe via Says Ju�u1l1 �4 <br /> St and.rukis of <br /> «ng s&e of lot,loull1w ofµsrs m in refetbn wed bwlidhgs.ate~ be*W 06 app1. IN - <br /> r <br /> FORDVARThAENI',USEONLY <br /> A*UdATION ACCEPTED BY- <br /> REVIEWED BY.......................«._...„.. j;�.... �»».�.....»»............„. DATE......��.,r.....:.... <br /> k BU)LDI G PERMIT ISSUED......«.„„................. DAjE...„,..»..»r'-------� <br /> and/or recommendations............„». ». <br /> -T 7...................................................... <br /> ` ».........................„.............„».............„..... <br /> t ....�..„...�................................................................... .... ......» „»+•www+•w..�+.»...•.wrar �' fi tri A <br /> 01 <br /> PE�MlIT No.f.4�. ...... ISSUED...... �.�; � (Date) FINAL,',,INSPECTION:BY• <br /> t �* .... grat� <br /> s _ t rI <br /> Y <br /> i SAN JOAQUIN LOCAL HEALTH±OISTW ,r <br /> ' .130 South A plow St M <br /> Steeklelr�Ciallf0lll�e' r `k <br /> M 9.50 W-1639 <br /> r <br /> u <br />