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' <br /> APPLICATION FOR SANITATION PERMIT Permit No. --'----../.--..l.. <br /> (Complete inDuplicate) Dmfn /os~v*6` _-/1/�/��/S�r <br /> � <br /> | b hana6v made to the Son qDistrict �r a permit to constructconstructand [n�o||the work herein 6cscr|6o6 <br /> lhis application is made in compliance with County Ordinance No. 549.JOB ADDRESS AND LOCATIOK, <br /> ' <br /> S <br /> ' -----'------'-------' <br /> wner <br /> ' ------------- P6�no---.-_-____.__ <br /> -__ ' +� - <br /> Contucto�s Name--. .--.._��--.- ------------------------------------------ Phone <br /> Installation will serve: Residence [�f Apartment House E] Commercial 0 Trailer Court El Motel'[] Other 0 <br /> Num��rof |i�nguni�� ��- Numbnrof �dmoms ^� Num�� of6m+h, --- ^ �� �s - <br /> / '' -'---- <br /> Wafer Supply:Suuoly: Pvb|ic system G3 Community system [] Private [] Depth to Water Tm6|- ^�� ft <br /> Character of soil to a depth of feet: Sand E] Gravel E] Sandy Loom El Clay Loam [] Clay [] Adobe 0, HnnJpuo [] <br /> P,ev|mmx Application k4m6e/ Yes [] No,& New (�ona+mvflon� Yes �] No .��_ -`. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No wap+lc tank or cesspool pwrm0foJ |{ public sewer |o available within 200 feet.) <br /> Septic � '/IlTsfance from neures+ well-----------------Distance from foundation--------------------MatorioL-'_---------___.- <br /> LJ ��«���~-N��o| compartments--------------------------Size---------------------..........Liquid 6opfk.-_------Capacity-------.- <br /> Dispoo | | Distance from nearest wu|i-------'Di,tonce from foundation--------------------Distance to nearest lot line--.-_-- <br /> [� of lines---------------------------------- Length of each line----------------------------- o{ french-_-.'''-''-''-' <br /> T_�po ofCte, material'''_'''-'''Depth of filter mvt+rm|'-'''- 'Total length----------------------------------------- <br /> Seepage Pit: Distance to nearest well from U +o n�ona� |ot |�ne-- /e /- -° <br /> Number cfpits------/-------------Lining mu+er|oL_4�/� Diameter- .—Da�t�. ^.---. ' <br /> Cosqpoo : Distance from nearest well '-'---Distance from foundation---------------- -Lining mmtrrinL''-----'-''---'- �v <br /> El Size: Diameter_- -----------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy- Distance fnzm nearest well '--''_'--'''-'''- -_--Distance from nearest building-_-'''_-._-'-'_-_- <br /> 0 Distance to nearest |o+ line--------_--'''''-'-_---_.'_---'--'_'''---_.-'''-'-''-'--- <br /> Romode|ing and/or repairing (describe):----------------------------------------------------------.------------------------------------------_---------------------------------------------- <br /> --------------------------------------------'------------'----'----'------'--------'---'------'---' <br /> —''------'-----'--'-------''--''--'--------'------'-----------------------'---------'' <br /> '----------'------'------''------'----------'--------------''--------------- <br /> I he e6 erfif that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> c r Y C_��awT, and rules and regulations of the San Joaquin Local Health District. <br /> ordinan e$, St <br /> -------/_�' r��------------------------------ ------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> REVIEWED r By : 7'�--------------- <br /> ------------ <br /> ------------------------------ <br /> -------------------::� --- - ---- ---- ---------------- ----------------------------------------------------------------------1�----------------------I--- <br /> -- -------------------------------------------------------------T----------------------------*---------I--------------------------------------------------------------------------------------------- <br /> ''--'-'----_'''_''--'''-'---'''-''''-'''--''-'-''''_''-----'''�-''''--'''-'-'--_-_-' <br /> F <br /> FIN/\L INSPECTION BY:--' --------------------------------- Date--'' / --------------------------------------------------------- <br /> y ' -`� ' <br /> SAN JOAQO|N LOCAL HEALTH DISTRICT <br /> /go nv"*h American Street 300 West Oak Stw"+ /xo sv*umom Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ss-v-2M m°.a°a v/-2/oo <br />