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FOR OFFICE USE,.' <br /> /y APPLICATIONFOR SANITATION PERMIT PmnnitNo` <br /> ' in This Permit Expires yea r r From Date Issued Date Issued ' - <br /> Applica-fion is hereby made to the San Joaquin Local Health 6isf rict for a permit to construct and installth work herein described. <br /> This application is made in compliance with County Ordinaric"o. 549. <br /> JOB ADDRESS AND LOCATION---- � � --'''---.'-''-''--''_-'-_-___.-^---�- <br /> -------------- <br /> ------------------- <br /> Ovnors Name rmx6 _*��x � R'ohca X - ---..... rnmna�e(._A� Q�.. <br /> Address------------------------------------------ -------------- � J---?C ----------------------------------.._-----''----- <br /> ' <br /> Con racto/s � <br /> ---------._ _--.. Phonw <br /> Installation will serve- Residence [I Apartment House El Commercial El Trailer Court [] Motel 0 Other,kj <br /> Number of living units: &.. Number ofbedrooms ./,~��um6e, of 6o�o /�- Lot size -^���.'� ���~��-�,���'��''��° <br /> �.' - -- / <br /> Wafer Supply: Public """ter` oy,*am [] P,�mte 0Deoth to VVa�rTo6|a295� ft <br /> ' - ~ <br /> Character of m@ to a depth of feet: Sand C] Gravel E] Clay Loam 0 Clay E3 Hardpan 0 <br /> Previous Ap plication <br /> MNx6e: Ufve,'6o*e-------------------- N mw Construction: Ye, E] FHA/VA. Yes [] NoEl- <br /> TYPE OF |N5TALLAT|C}NANDSPBC\FlCAJ|ONS: i <br /> (No septic tank or cesspool permitted. if public sewer is.available w ithin 200 feet.) <br /> Septic Tank:-5 Distance from nearest UI1ob�.---Distance from foundation----{.6[----------Material -. - ---------�.:---.� � <br /> No. ofcompurtmon6-�f--------------------Size- '/.?�. Liquid ep+h...... Cupucify.=�5<Rg29_ f�. / <br /> ex <br /> DisposalFio|6: fU �� - from f �� - lot | "27° � <br /> length----- <br /> See v/st°npn to n=* �/=�nDistance / <br /> Nu�6or of p��'-�z'__..Uning materia Size Diume+ec���������-.Dap+�-',l��.�-_---.- ^£� <br /> ~_ . ' -�� <br /> Cesspool: Distance from neo,o, well-----------------Distance from foundation--- ----------------Lining mot9ri*L''-''-''---'_-- <br /> F1 I�ze: Diameter —--------------------------------Dap+E -------------------------------------------------Uou|6 Cap����._-'-_..__go|,. <br /> Privy: D�st nc= fn,m nearest well '----------------- ----------------------------Distance from nearest building'-'-_-'---_.-''-'' <br /> [� Dis+unuv to "oom`t lot-line-_--_---.-�-��-_-'__-____-------.__--__-----.--.—_� <br /> , � ^ <br /> , <br /> RomodoSng and/or repairing (6a,cribe)- '''' ' '- _--__'--'___--''----'--___'-_-_''---_- � <br /> .—___-�._---_--__---�__.-��`-��- -�__--_-_�--_---`_.--_-__.-_----.. <br /> . <br /> �. . � <br /> ---__-_-_-_---_-----..__.__--._-__- '�-_-_---___---_--_--------'---__-_._--- <br /> _____---_________________'____________________---___'__---`_____ ---------------------------------------------------------------- <br /> I hereby certify that I have prepared this application an&thaf the <br /> work <br /> ordinances, State laws, and rules and regulations of the San Joaquin LorAHealth District. <br /> (Plot plan, showing size of lot, location of system in relatio ells, 6uil gs. etc., can be placed on reverse side). <br /> FOR'DEPARtIVIENT USE ONLY <br /> Alterations and/or recommendations. <br /> -79---- ----------------------------------------------------------- <br /> , SANJOAQU|NLOCALHEALTHD|STRICT <br /> 13OLSOUth American Street 300 West Cialkvtreet 1s*Sycamore Street 205 West 91h Street <br /> St*ckton,California Lodi,California Manteca,California Tracy,California <br /> "".""",.="".""",."D.""°."" ~ <br />� � <br />