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FOR "++=^^,~` ^ ` . <br /> .................... <br /> APPLICATION 'FOR SANITATION PERMIT Permit No. <br /> ------------------------------------- <br /> y/ � ��^--n,pleYe8m Duplicate) Date |�uw6 <br /> ^ Year <br /> This <br /> Permit <br /> Expires <br /> rom <br />--------� �m hereby m��� to the 3mn'Jo�qu|n Local Hou|Hn District for u perm|ttncon�r c+and install the work herein dev*r8*�d. <br /> Application - <br /> This application hmade in ,ompliance1wi hCounty Ordinance No. 549 <br /> ' � <br /> -_- ADDRESS ' . <br /> ^[)wvors Name-------�--���__�«J�u . -'--'----------'—'—'-- ' '^~e--'--'—''---'--- ^ <br /> ~~...-_ - Name------------- <br /> -` <br /> Installationwill serve: ResidemceE!r_Apartmen+ House �� �mmo�m Cj Trailer Court 0). Motel 0 �6� [] <br /> — <br /> Number ofliving units. Number cfbedrooms 'A= Number of baths -1--- Lot sizle ------ ---X-6.0 <br /> -----..-_--.--_.'. <br /> Commuy �yyWater Supply: Public system «� m <br /> [] Privato [] Depth n, YYufm, Tu6le 4P, ft. <br /> Character of soil to m depth of 3 fmm4 Sand [ Gravel [ S 6 Loam [] Clay Loam [ Clay Adobe F1- F�ardpwn0 <br /> Previous Application Made; (If yes,date-----.--) No Ne~ � <br /> c�o�s+m�+inn� Yes Q���o [] FHA/VA; No ��-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool 9e'ifted ifpu6ru sewer is available � <br /> within 200 feet.) <br /> Se Distance from nearest well----------------- from foundation--'-_--��u+eriuL---.------.....-.---- � <br /> —' No. o{ compo�m�nt,--- -�--S|oo-....-.-----_.'^..�quiJ 6=p>h--------.-Cupudt�---.-...�-.. � <br /> ~�� / > <br /> Distance from foundation-24. <br />` - -__. <br /> � ~�r �~`~~/ Number-- e from near I P <br /> Tvoe of � to � -------------- � Lengthpth nf G|tor material '� � ]�tn| �� , <br /> Cesspool:See Pit: Distance to nearest f---------Dista,qa-fx m fo nclafiol__Z,_� Distance to nearesf-�4 lirLe-0 <br /> Distance from "eoro, woL''-'--Q��ncofrom ^ounuotm"—''--'-umng morenu/'-'`,--_._--_^-- <br /> El Size: Diameter - --------------------------------Depth----------------------------------------------------Liquid <br /> [] Co <br /> pacH9.'',-.r--.-- <br /> ----------- <br /> Privy: Distance °pL------_-------.Di�unco from neu,m, building--' _.___-_ <br /> D|�onco +o <br /> na*n�t |v� |im� ___- - __-'---'_--'�''-'--__ <br /> �� <br /> Romo6e\ng and/or repairing ----. ^' ---- �`- --'------'' <br /> '--.-___-'�_.'--'_-'_-__.-�_.''-_.'--'-__-'---'__.-_.''''-_''--_'--_'-'-'_---�---_--''_-''-- ' r», <br /> ______....___--__.___.._--.--,|-----_.-----------------''-------'''''---------'''''------'-'-----'' �^ <br /> _________.__.__._____._-|.__-_-__-'-_-'----------'---''--'-'--'----------'----------- <br /> I hereby certify that I have prepared this application and A +` n an <br /> will6e6 accordance with San Joaquin County <br /> ordinances, State laws,-and rules and, regulations of the n J quin Loc I Health District. <br /> and rules an regu a <br /> I ons of <br /> q, In Loo <br /> t. <br /> (Plot plan, showing eize of lot, locaflo:'n of s el ion to wells buildings, etc., can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y--.- J ..".. ------------------------ <br /> l u*/�.--w .----------. <br /> REV|EVED BY---------------------------------------------------------------------- DATE- ' <br /> BU|LD|NG <br /> | <br /> PERMITISSUED---------------------------------------------------------------_-'----'--' DATE..------r=......--- ------------ <br /> Alterations <br /> ---- | <br /> Alterationsmnd/mr recommendations----------------------- ----------------------------------------------------------- `---------------------------------------- ----------------................ <br /> __-'-_-'_-''--''----._-----_---`,_-'-�^-_- <br /> - / <br /> '---' ' '' -'' ^ m .� <br /> -._ -''- ---'-_--'-_-''---_.-��.^ ��-_.''---'_-.__.---.. <br /> ---'_-'_------------- ------------------------------------------- ------------------------------------- ----------------------------------------------------- <br /> ' <br /> --'--------------------------- --- ------------------------------ -------------------------''--'--'--'-''-''-'-'''''----'''''---'-'- -----''--------- <br /> ��' <br /> FINAL INSPECTION BY�.--�=�.�' -------.—.. Dotm--.=..�7������e�`�-------.---'- <br /> � SANJOAQUVN LOCAL HEALTH DISTRICT <br />� <br /> 130 South Americanotreetl �e��S� 1���o�. u�W��o� <br /> Stockton,California | Lom'manwrmia Manteca,California Tracy,California <br /> RS REVISED o'opzm *'ecATLAS <br /> ' <br />