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�c^ � '/~ <br /> / <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit <br /> ��m�p|�� � C����+� <br /> ----'--------------' ^ ' Date |oouad ---- <br /> ---------------------- I]��Z.='� <br /> Ago|icotion 'is hereby made to the Sun Joaquin Local Health Dinfricf for o permit to construct and install the work herein 600*ri6e6. <br /> , application is made in compliance with County C)nJinan:o No. 549. <br /> -~- ''--'--- ' '''- OM�------------- <br /> ---------------------------------------------------------- ---- --------- Phone..—_-_—__.__' <br /> . _____''~._--�--- -_ --'-__.-__'__--_--. <br /> Contractor's Name_-_~..----- __--'---.—_.---_--'---_—.. Phone -_'--_. ---------- <br /> Installation ,ill serve: Residence ent House [] Commercial [] Tmi|o, Court Motel F] Other [-] <br /> � <br /> Number of Uving units. ..vx- Number ofbedrooms --1 -Number of bu+6, -/--, Lot <br /> Ln+ size - 04uV--------- <br /> Wate* Supply: Public system 0-~CommunKY system E] Private R Depth to Water Table &t�? ft <br /> Character of sp7| to a depth of feet: Sand L] Gravel [] Sandy Loam [] Clay Loam [3 C|oy [] /\6o6n ���Hu,6pon [] <br /> Previous Application k1m6e/ Ufvos'dote'-- --------- ---> NnQ?~'NewConstruction: Yes El No �HA/VA. Yes [] NoRL_._ <br /> � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool pe,nniMw6 if public sewer isavailable within 200 feet.) . <br /> 6 �u� k- Distance from nearest woU-----..Distance from fvundotion-------��uter[uL----------------� <br />~ No. of comportmen+, ------------------------Size---- ---------------------------Liquid 6ep+k--------.Capacity'_---.------ <br /> Distance from nearest well---- --------Distance from foundation--------------------Distance to nearest lot line._-'--. <br /> Num6er of lines-----------------------------------Length of each line---------- -------------------Width of french-'-''-,''---'--_ <br /> ' " Type oJfilter material -_----_---_'Depth offilter material —._---..Total length------------------------------------------- <br /> Seepage Pit: Distance to neona+ elL.----���.. 6 vn-,tO.-� to nearest lot | <br /> Number ofpits-------e�------------Lining material -AFePwo46'Size/ Diomofe,-S� --.De --'�- �C���� - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material ----------- <br /> El Size, Diameter'-'''''-''-- ----------Depth------------- ----------------- —''' --------Liquid Capacity----------------------------gals. <br /> -� <br /> Privy: Distance from nearest well-------------------------------------------------Disfancu from nearest building--------__---' <br /> [1 Distance fp njae=f lot line- -'''—'''-'-'-' <br /> , <br /> Romo6eling unJ/v, repairing o\:--'''--' ' ------------------------------------------------------------- <br /> '----------'--'----------'—'--'----r-------------*°'--------------------- ~- <br /> ---'-''--'-''--''-'''-_--'_-'---__---_''-_.-''-_'-'__.-__''-_.--__'_--'-''-_.---''_-.'-'-'-'- <br /> ------------------------ ----------- ---------------------------------- ---------------------'''------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that work will be done in accordancewith San Joaquin County <br /> ordinances, State laws. and rules and regulations of the San Joaquin Local Health District. ' <br /> (Signed)------------------;,..". -----A6!,c1 .----(G4ofteo <br /> (Plot plan, showing size of lot, location of sy; in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ............... .r <br /> Alterations and/or recommendations-.-- <br /> -- ------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------'- <br /> ---- <br /> ----------------- ------------------ --------------------------------------------- ------------------------------------ <br /> _ <br /> ---__��_�-- _---_--------_ <br /> FINAL INSPECTION BY:--'' [ L � � �/ <br /> um-- --'''^—''---'-'-'-- <br /> / <br /> ` <br /> LOCAL HEALTH DISTRICT <br /> 1601 m.w°"elto"Ave. 124Sycamore Street uoyWest 9th Street <br /> mmckm" California Lodi,California Manteca,California Tracy,California <br /> � <br />