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APPLICATION FOR SANITATION PERMIT Permit No. <br />' <br />(Complete in Duplicate) Date Issued --- / Wxk <br />Timade to the Sun �Local Health District �r u permit to construct and �,t, 'the *or- herein described. <br />su����mo6e/ncompliance with County Ordinance No. 549. <br />JOB ADDRESS AND ����c��� ���'����» <br />- ---~"��v--'' -------------------------------------------------- <br />Owner's <br />-- -- -' <br />WX <br />Is <br />/ _��� <br />Contractor's Name --------- �/?o - 7- V ----------- ------------------------------------------------------------------- Phone.-Y-uo--�� -- 61'/14 <br />Installation will serve: Residence Ejj�Apartmenf House [-] Commercial El Trailer Court [] Motel L] Other [] <br />Number of living units: -J----,,N�u�er of bedrooms z;2 --Number of baths J---- Lot size ------ <br />omm <br />Water Supply: Public system [%�- ommunity system F] Private E] Depth to Water Table 4-4�ft. <br />Character of .~. .. ~ °er" of ° feet. Sand E] Gravel EJ Sandy Loam Clay Loam LJ Clay LJ Adobe 0- nardpan LJ | <br />Previous Application Made: Yes E]No E?~~lNuwConstr-- <br />Construction: Yes �0' mo E] FHA/VA.Yes F1 No E+ -- <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank mr'cosspop| permitted if public sewer is available within 200 feet.) <br />Septic Tank: 7777777istance from foundation- <br />^ Maferial(2121'43�0� <br />WNo. ofcomportnents--&----------------- Sizo--°���^�.»�,�/--- Liquid 6ep�h--��^ ... ....... Copudfy-'&��7�.�lm%&u. <br />D|,poou| Field: Distance from nearest well--�---°Dis+ance from foundation --- ------ Distance to nearest lot Num6a, " <br />�r ���������°�-' �-----"- -� ---� ---'- `~ ''' of ''`^`^^ ~ <br />/ Tvpn of filter moterinL-.�.���n=��Dop+h of S|+ar mnn+nrioL.^v-.-Jota| length --. ��«7 «_-_ <br />Soepoge Pit: Distance to nearest well-.--- — - <br />x0_�'+o <br />' <br />Lining material ..�D|�me+ec DepNumber of pits ../---+6..06E--/--^�_~---- <br />Cesspop|:Distance <br />� <br />��t nc� [nzm npor�, weL'-'---D�fonrnfm�. foun���ion--_''���Uning mafor�L'-'�-����-_-''- <br />Privy: Disf nrn from nearest well --- ''---''-''''-'''--Distance from nearest 6uU6ing��-_''--_-'-''-'- &� <br />----- <br />Remodeling and/or ' '' ------------------------------------------------ <br />------------- <br />' �� <br />__..-_-----_------.----�=-�~~- --_.. -.---'-_---------.-.. �^ <br />--__-___.-_---'___--_---_—^..__.__-'_..__._---__-__--_-.-----'-----.------------_-.--.----.. � <br />._--.--_--'_-__-_--__.----________---_-_'__--.___-_-___'._--_-____----------.. - <br />I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br />ordinances, State laws�,a�ndles and regulafi s of the San Joaquin Local Health District. <br />(Plot plan, showing size of I ocation of system in relation to wells, buildings. etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />� <br />-------------- <br />/-''--'''--'''''_--'-_-''-'-'--'--'''_'---_-_-.''--'''_-.'__�--- <br />�-�1-u-c\'------- <br />- <br />— ��/ --._--.-_--_---_--_--_-'----_-_-_--.-_---_____.� <br />�—'--''-'-''-''-'''�'/' '''--- -'''--'''--'--'�'--''''--''--_''-''_-''-' <br />RN/\L INSPECTION BY�-../&�/�����-/�/.�.---�� Du�� <br />� �/ �,~ -~ '''---'--'-'v_�-' ' -''---�-'— <br />~ �SAN JOAQUIN LOCAL HEALTH DISTRICT <br />mo S""h American Street 300 West Oak Street /xm Sycamore Street m* m"*h T,' Street <br />smokt". California Lodi. California w=m"o.Ca|Komia Tracy, California <br />