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� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> � Dmo�m�1 <br /> (Complete Duplicate)' Duto |ouoJ <br /> o| mno6o to the San Joaquin Local Health District for it to construct r�6 install the worherein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> W 02 <br /> 41 e <br /> JOB ADDRESS AND L9CATION---e�L._Z-f_ ------ ---- -- ?-�------- I...................Z� <br /> -.P.- -/)w/1 <br /> Contnuctor'sNuma. ---.-------------- ------------------------------------------------------------- Phone------ - ----------------------- <br /> Installation will <br /> .-------.|nstaUmtimnviU serve: Residence Apartment House 0 Commercial E] Trailer, Court [] Motel {}+ker [] <br /> Number ofliving units, -1-. Number of 6o6'oom, Z- Number of baths Lot size -'/-- �------------------- <br /> Water Supply: Public system F1 Community system [] Private k Depth to Water Table 5-0- ft <br /> Character of muU to a depth of 3 feet: Sand [] Gravel E] Sandy Loom RD Clay Loam [] Clay [] Adobe [] Hu,6puo [] <br /> Previous Application Made. Yo, E] No O� New Construction: Yes 00 No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank m, cesspool permitted if public sewer isavailable within 200 feet.) <br /> � <br /> Septic Tank: Distance from nearest wnU_�.%�..'-Di dation--- eri | --__ <br /> No. of compartments--�2-----.�-..Sizv..��-���.��----�quid depfh-.�� <br /> --------.(�opodt�./��n*_-�-' <br /> O��| Field: Distance from nearest �U'��--.Distance from fo6 tio ~O-* Distance <br /> O�i Number o{ lines-------- --------------: Length of each Ii n`67 <br /> Typo of filter mn+oriaLPt'.--------------Depth of filter mu+e6oL/f*----------- ofu| length'IAQ-._____-.-__-- <br /> Soopaga Pit: Distance to nearest well-_-- from foundation-------------------Distance +o nearest lot line-.--.-- <br /> [] Number of pit` -'''_''-Lining material-'�-_�'�-'Size: Diameter-----------------------Depth '�--'-''-''— <br /> Cesspoo|: Distance from nearest well----------- from foundation-------------------- muhori*|-----._-_.__ <br /> [-1 Size: Diameter------ ''-''''-''-- .... ------- -----Liquid Capacity--------------:n-------------oals.' <br /> Privy` Distance from nearest well---------- ------------------------------------Distance from nearest building--------------------------------- <br /> __ <br /> �] Oist nce to nearest lot line_ '—''-'''--''_'—'__-'----'''_-'-'----'-''----'-''________ <br /> RemoJeUng and/or repairing (describe):---------------------------------------------------------_. ----------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- <br />- '-''-'-__.'_--''---_--'__''_--'--_'---'_'--.'-_.-__.___''''--'-_--_'-_-'--'_-__.''-''---_''''- . <br /> ._-_._---'_---__.____-__---_-__.--_-_--._-._---_'-_--_.__--._---_.—._--- <br /> ordinancesI hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> Health District. ~� <br /> (Plot plan. showing size of lot. location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> --'--'-'-'----''''-'''--''-''--''---'-'--'''--'''---'--''--'''---'---'--'''--'-'-------''-- <br /> '--'----'''-'—'----''---'----'''--'---'-'''-'''--'--'''--''-'''-'''''-''-'-'---''-'' <br /> .---'-'--'--'_'—_'''--'--..---''—''--'--'''-''---''-'—'_'--'''-'''''------'-'-'--'-- <br /> FINAL INSPECTION BY:' -------- -------------- Do+e .� '-'-'-''-''-'--'- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /30 south Americen street 300 West Oak Street /»z Sycamore Street m* North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E"_~ °G4~^,°"". <br /> _ <br />