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APPLICATION FOR SANITATION PERMIT Permit No. -_'�.����a <br /> ��mm�� � �uu�a�\ � <br /> ------- <br /> (Complete ''--` Date |sxuo6 ../.A.'.�.-�� <br /> App||o,f�n is hereby made to the Son Joaquin Local Health District for v permit to construct and in�o|{the work herein described. <br /> T�ixupp||mot|on is made |n comp||�ncnwith C Ordinance No. 549. <br /> � <br /> O �� �� . <br /> JOB /\DDRE3S ���'.�-�-����r---_---------------_----_--_-.-- <br /> Owner's, N ---_------_--------------_----.----' Phone------------------------------------ <br /> A66 ..��/r! ----- <br /> Contractor's Name.-07k-_-�%�^-------------------------------- Phone_--_----_---.-' <br /> <nsta8at|wn will aon~a: Residence <br /> Apartment House [] Commercial [-] Trailer Court <br /> [] Motel [] Other E <br /> Number of living units' '+U-. Number ofbedrooms K----- Number of 6u1ho j-.. Lot size <br /> _-------_---_--.-.----.- / <br /> \mato, Supply: Pu6|ic system Community system F] Private E] Depth to Water Table -------- ft <br /> Character of soil to a depth of feet: Sand [] Gravel E] Sandy Loam 0M (�|oy Loam [] C|�y [] Adv6o [] HmnJpun <br /> Previous Application Made: Yes E] No V Nev Construction: Yo, [] No R <br /> Y-. #11 � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ~~ <br /> (Nn septic nr �os,pop! permitted R public sewer � a,aUa6|mw�hin 200 feet.) � <br /> ` �c ' « ---�� <br /> �op+\� Tank: Di`+°nry from nran,,+ ~oU'�r^�v�..-D�danco from foun6 �. <br /> a+ion- !�.-. u+eri�| {@����� <br /> No. ofcompartments-.-'�--------------S|zu-%a.A'X__!*-----------Liquid clupth-_,[-----------------Cupuci+y 1-— <br /> Dispo`o| Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line,--__.--- . »�� <br /> Num6or of lines Length of each line-''''��''-''''_WidH, nftn,nch_'__3-''-_''--'-- <br /> Tvoe of G|+or mofoha|-1-4Depth of filter muh,riuL.L2.............. length----01/0---_-.__._--_- <br /> 3eapage Pit: Distance to nearest weL_-----'Didunoe from foundation--------------------Distance to nearest lot line----------------- <br /> F Number of pUs----------------------Un�ng material----------------------- Diameter-----------------------Depth--------------------------------- <br /> Cesspool: <br /> '--_---_''_-'Ces poo : Distance from nearest well-----------------Distance from foundation -----------Uming motehoL._—._--____- <br /> El Size: Diameter-------------------------------------- ----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from noo,e, well --------'_-.__.Distance from nearest building--_.__..__---_- <br /> [1 Distance fonearest lot line-----------------------------------------------------------------------------------------------------------------------------_.___._ _ <br /> Remo6elingand/or repairing (de,oribe):-------------------------------------------------------------------------. ----------------------------------------------------------------------------- <br /> ----------------------------- <br /> ---------------'------------'--------------'---`--`-'---'--'—`------' <br />� _--___'___-..____-___-_-__-__..___'.__--_----..___-'-______.----.___.____..__.___---_. <br /> -----'--'--'''-----''-----'''------'-'---'-----'-----'-----'-----''-----'----''--------'—' <br /> I hereby certify thatj have prepared this application and that the work will be done in accordance with San Joaquin County <br />/ o,mm <br /> Y:-----------------------Zi I of, ----------------- <br /> (Plot plin, showing siz location of system in relation to wells, buildings, etc., can be placed on reverse side).FOR DEPARTMENT USE ONLY/ <br />^ <br /> APPLICATION - ----------------------------------------------------- _ -----__________� <br /> KEY|EWED BY-----Cael,4061------------.--.-.----------------------.. DATE---- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE_--_-----_-.________._ <br /> AKv,uMonoon6/n, ,ucommenJm+lono:------- ----------------------- -------------------------~------------- --`_---___..---�_ <br /> ---'----'----`--'--`---`-----``````--``-----'---------------'---------------'-----'----' <br /> --''--_-'_-'''-_-'------_-_'�'-_-'--'----'-'---__-_-__--_-____-__-..___.----.-__..__--_---- <br /> ------'`--------`--`--`-----------`--------'````-------`````-------```----------``------------```��---`�`����`` ----'�``-----------``-­----`------------------'���---- <br /> -----------------------------'---------------------------------`���������������--- --------`-------------------------------------------------'----------------------`�����'-----'' <br /> FINAL INSPECTION BY ---------------------------- Dafo' �� ' --------------------------__._. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /so South American emm mmWest Oak Street mx Sycamore Street ow North "C" Street <br />^ s*""kt"". California Lod/, California w°m"=. California Tracy, California <br /> ` sx-v-uw 8'5/ x°./"°a vv'z/oo <br /> ` /, <br />