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t~~- <br /> APPLICATION FOR SANITATION PERMIT No _=..?...&I.......... <br /> (Complete in --''--' <br /> - Date Issued ----------------------- <br /> Aplica-l`ion is hereby <br /> mo6o to the Son Joaquin Local Health District permit foconstruct and install the work herein 6w,c,^ibocl. <br /> Thisapplication is made in compliance with County [>nJinunco No. 649. <br /> ' <br /> JOB ADDRESS AND L3(�AT|{�N-. .�^*amzw^'��-&�g��@*�,..a=---_----------.-------------.----. <br /> D�nn''� Name--------------- ."-'�. --'------_-^_-.-----.------- P'uno~4/4.��7�����- <br /> AuuZ_42.Z. ---------------------'----.----.----_--- <br /> d� <br /> ._-_._. 'ill- _serve: 'Residence_ _ .~ ,--_' House ^~ Commercial L~ Trailer Court ^~ Motel �~ Other ^~ <br /> Number of living units: �- Number of bedrooms Z ` m � of baths I- Lot size ����4�°_�._ _- <br /> �~� ' <br /> W� Supply: PublicPublic �� � Community system E] P <br /> ' �� -_� Depth to Water Table <br /> Character of w6| to a depth of feet: <br /> i 5 � 1. Gravel [ Sandy Lu Clay <br /> y Loam [] [Jay 0 Adobe OJ~�Hn,6pmn [] <br /> Previous Application Made: Ye, ;�`New Construction,. Yo, ~~°mo [] <br /> ' <br /> ' <br /> TYPE OF INSTALLATION AND SP£C\RCAT|ONS; <br /> (No septic tank:w, cesspool permitted if public sewer isavailable Within 200 feet.) . <br /> Septic�ank: Distance from nearest wel110_9__+.Dist66ce from foundation--- Material...C/C4,L,,x4__A)------- ---------- <br /> '^~' of compartments'Z--------------------~' Liquid ~~p '^'~^-~`-------------Capacity------ <br /> ^==-�~�- - <br /> D �6. Distance -from nearest we| «�i�~�- ^�p�r- " <br /> ��� <br /> Number of |��_ � '� L�o� of each |�n_ ' ~ YY�� <br /> -- <br /> Type of filter mm+�rinL�� j^ ��~--� .- pf ��er �n+�r�|' --'To�| |�n"+� JL '--'-'' <br /> ' ' <br /> 5ee Pif:- Distance to nearest well '-- '-'Didmncefnzm fou6dmf�����-��__D�tnncefo nou,�tlot |in�.''�'-- 0 ^ <br /> Nu'n6er of p�,''-------Uni/ g mu+er�L-''-'' -' ' : D�mefec-'''_-. Depth <br /> � '-,-.'-''--''- '- <br /> ^ , � � . / <br /> Cesspool: Distance from nearest well ''.-'-`_Distance from foun6ation'------------ -----Lining material <br /> Sba: Diamefoc -------------------------------De_ot .---------_-�.- -----------------Liq~o|d Capacity- . gals. iv <br /> Privy: Distance from nworno ---- ------------.^ --------- fn,m nno,es+'bui|6ing--.-------_-`------ <br /> El -- Distance +onearest lot line,. -.----....-----_.--------.--'�---'-_ _.-°� ___''. <br /> -_'''-'..-----c-._---- <br /> Rnmode|ing and/or repairing o\�:--------- --------------------------------------------- ---------------------I <br /> __.__'o <br /> ......./-------- --------------------------------------------- <br /> k ' <br /> Y ~ � <br /> ---_---_ -'--_----- . ___ -__.__--___-____._ - __` _'-----------_._---_--.. <br /> ----------------------'----'--`---'---------7----''--' --'---------''---------'--'----'' <br /> ----- ----------'------ '-----'--'--'--------------------''--'—'-'-'----'------- <br /> ' l <br /> ' ~"~~ <br /> ordinances, e laws, a d rules d re-gulaflons of the San Joaquin Local Health District. <br /> (Si <br /> ' ` <br /> . �3 ------------------- <br /> By: <br /> '_--.. _-_.__-.. can� �� placed *m reverse side)..plan, size of lot, / ;f system in re " <br /> FOR DEPARTMENT USE ONLY ` <br /> __7 <br /> -_''_'--''----''__'---_''--'-'-^^�'-'''-'.--�'--'-_'--_''--'''--''--'-''--.'--_.'''-----.__._-_--- <br /> --''-'''-''-'''-----''--'''-''''-''''''--''-'''--'----'-''---'''---'-'------'''---'''-'----'---' <br /> ' <br /> --''-'--''_''''�`^-�.-_ '-''-''-''-- ----------'' ------------'-'-''-'''---------- ''-''-_--''-'-- <br /> .� <br /> �� -~ �_�-_ <br /> �n � <br /> RN~�L |NSPBCT|�3N BY:---..���.�,"���.---_-_.-- ~ � � Do+e--mx�'-...�~---.---_-------__._' <br /> ^ SAM JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 south American street 300 West Oak Street /32 Sycamore Proof mw North "C" Street <br /> Stockton, California 4,dit California Mm"mco, California rmw» California <br /> - ss-9-'2w � x"v/"oa W-z/oo � <br />