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, �� <br /> =w ~ � <br /> APPLICATION FOR SANITATION PERMIT Permit No. - <br /> ' � o ��m,nphfe`/n O��|�mf� <br /> ' ' '-- - ' —°� � <br /> Date |oun6 ����� " <br /> - - ' '- '-_' <br /> ` <br /> �r mu6ofoH,eSun Joaquin Local HaoHh District for permit to construct and install the work herein described. <br /> '^'application is made in compliance.-With County Ordinance No. 549. <br /> --------���------- _---__--_---__.__-_--_ . "".=_-__.------------------ <br /> Installation will ,w,"e: :Residence [] Commercial E] Trailer Court [l Motel El Other I-] <br /> Number of |ivi ' - / Number / Number of baths / <br /> ---- Lot size ------V� <br /> Water Supply: Public:system E] Co <br /> mmunify system -11- �_to Water T6ble -------- ft. <br /> ] Gravel 0 Sandy Loam E] Clay Loarr� 0 Clay E] Adobe [R-14&Fdpan <br /> Previous Application Made: Yes o B'_ New Construction: Yes Rj_-No—F] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic fankior cess'pool permitted if public sew6ir'ii ayaila6le' within 200 feet.) <br /> Di�fance,'Jrom nearest �vell-----------------Distance from foundation--------------I----Material <br /> Septic Tank: <br /> Disposal Field: DistancAOM nearest welJ----------------�Distance from foundation-------------- -----Distance to nearest lot line------------ <br /> ------------------ <br /> CWp� ol: Distance from near�'Osf well__P_��isfance from foundation, Lining material-- ------- --- ------------------- <br /> Size, -------------------- (__0?e7Liqu;d Capacity.... .. ----------------gals. <br /> I here6y,certify that I h�ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and!, and r gulations of the San Joaquin Local Health District., <br /> (Signed) __e_c-------- --- ----- ---------------------------------------------------------------------------(Owner and/or Contractor) <br /> Mot �mn.���~������� �t���a��n ��� � in ,e��*n to ��i� 6un���o �f�. �m� .'�� ' nn�---''----''-'--'-- <br /> A <br /> ` / , <br /> " FOR DEPARTMENT USE ONLY <br /> BUILDING PERMIT ISSUED---" <br /> ^ -iii---------------------------------------------------------------------------------------- .' ----------------------------- <br /> .---,—._-__--_----___.__---------_-_-..___._---_-__---'._-_._-_-''_-'-__-_.-'__' <br /> -'-- ----------------------------------- ''---'---'' . <br /> . <br /> � � '_-''_-- ''--''-_-'-_.''-'''-'''-�-'---''-_.'''---^-.-_._-�--'. <br /> ----'--'--------`^------------'`--'---'--------`----'---------`------- <br /> ----------------------- ---------------------------�'''_-'----'''--'_'''�'---'--.''-'''-'�'�-''''--.-''--''-''--:'''-- <br /> v � ''-'----'-' <br /> ���:~~� <br /> FINAL -INSPECTION BY _7 - �---- ..�—. ~ D*t�-.-���..�''��'��..^-�­------------------------------------ <br /> � <br /> ' <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> 130 South American Street " 300 West Oak Street ox Sycamore Street ' ow w**h ^c^ Street <br /> Sfv kfo". California Lod;. California . wmote"". California 7mov, California <br /> sS-9-2w x°"a°d vvo/oo` <br /> � � <br />