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. APPLICATION FOR' SANITATION PERMIT Permit No. <br /> (Complete ' ' Date Issued <br /> Application is hereby made tothe Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> WI 0 N------ <br /> Contractor's Name.-.-- <br /> Installation will serve: Resiclerice Apartment House E] Commercial L] Trailer Court E] 'Motel L] Other E] <br /> Number of living units: A----- Number of bedrooms .1"'--Number of baths j.... Lot size V,� eteA--Q- <br /> Wafer Supply: Publi� system 0 Community system [-] Private E] Depth to Water Table <br /> ' Character of sail to a depthC Gravel E~ Sandy Loam ^~ -`' --' D .--' El ' ~-~x~�� Hardpan <br /> Previouu �un kxm6o, Yes E] No�� New Yes �] No <br /> ''���� / r~~ ~ ' <br /> TYPE �f \NDT�LL�T��N /\ND SPECIFICATIONS: <br /> (No septic tank orce�io��� ��iml�m6 � �u6|imwo�mr |s�vmJa6|w ~�h|n��0Dfon�).. � __. . <br /> ' .� - . <br /> Septic Tank: Distance-from no*nostweU_----Distance from foundation------------------- Material --.---------.-- <br /> No. of 66mpartmerifs- Liquid cl <br /> D�s po a 1, Field,: Distance from nearest well-#-19---Distance from­founda'i�io ------/0------Distance to nearest lot line---157-25 <br /> Type of filter material-6-1'/iA --..----'Depth of filter maferiaI--­-/-,?.',*��Tf-A <br /> ElNumber,of pits------ -- -----------Lining material-----------------------Size: Diameter.----------------------Depth--------------------------- ... .f <br /> Cesspool: Distance from nearest well from <br /> . PF <br /> - - = - <br /> [� ��z�� �iano+or------------.-�opfk------..=.,~~,= ` ~~� , �u�J�o <br /> -----------------gals. <br /> Privy <br /> Distance to nearest lot |inv. Distono:"frpm nearest well---------- --------------------------------------Distance from nearest building----------------------------------- � <br /> � <br /> - 4x�� __________ <br /> ��. . /7 � ' ' -''-'-'--�-' <br /> ---' -'-----'---~~-'--------'-----'---7�--'-�'---------------------------' <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ...... ~ <br /> | here | G�ve preparedthis ' |ication and that the work will be done in accordance with5� Joaquin County <br /> ordinances, State laws, and rules and ragu�t�nsof +he San Joaquin Local Health D� � �. ' <br /> (Gign � 17 -.----------------------.(owner and/or <br /> ^ <br /> By:--�-..�.---.-_-....'«�_.-�-.�-'���--'----. ------------------------------ Rl |o-._--_. -- -.-�" ''.. -Contractor) <br /> ��t plan, showing size of - location of system in ,o�fnn +o *p1�. buildings, c., oan`6o '�*e6 nn r�r� side), �-----' -- <br /> ' <br /> � <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- --------------------- - DATE <br /> -------- <br /> REVIEWED <br /> � BU|L0N�� PER��|T |3SUED..."__.__-_--_ ---__._.. DATE­ <br /> ---------------- <br /> Alterations <br /> ATE -------------- <br /> ----------------- <br /> __.___ <br /> AKwrm+�nsmn6/o, ' --''''�-''--�---''--'----''''--'''---''------''''--'- -'''-''--- <br /> -------------'--''--------------------------'-----'--------------'------- <br /> ' -----'-''''--''--'---''''-''''''—''''''''-'''--''---'''-'-'-�''''-'--'----'-- <br /> � --''_--'-'-''- - � ^ _'''''-'_-----'_ <br /> � ---- '''''-_.-'-_'' .-'--''--''''-_'�---''--''_-'-'-'---''-_-_---�---'-'--_. <br /> -'''-'-'--''---'--':-'--' ''----'-'-_'�'-'''''-''''---'''''--'-'''-''--'-- <br /> . � <br /> �NAL INSPECTION BY�.O�---.--------------------------------------- --------- Date--. ��� ----.��'«�� ~°. -_-----. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /m south America" Street 300 West Oak Street oz Sycamore Street ow North 'C" Street <br /> Stockton, California Lvdi. California Manteca, California Tracy, California <br /> ES-9-2M 10'52 xv"u^a W-x/oo <br />