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� <br /> APPLICATION FOR SANITATION PERMIT 8 » <br /> �0 <br /> K��mo/�fm in �wok�at� <br /> , ' Duplicate) <br /> Application made to the San Joaquin Local Health Dist'ricf for o permit to construct and install the work herein described. <br /> This uppdicafionis made incompliance-with County Ordinance No. 549.JOB ADDRESS AND LOCATION----- ( <br /> -6, <br /> ----------�- <br /> Addnass____-__-.---. ------------- ---------------------------------------------------------_._____.._________.__ <br /> Co"+mcfv,s Name-----------' --_-''----''-''''-_''''-_''''-_.--_-.--. Phone'-__-''---'__- ' <br /> |nstaUmfion will serve: Residence D4 Apartment House'E] Commercial [j Trailer Court E] Wo+e| [] [the, E] <br /> Number of living units: Number of bedrooms [4 Number of baths P Lot size----- . 4)-v'--_------- <br /> Wate, Supply. Public system Community system E] Private F-1 <br /> Character nfsoil to depth of.3 feet: 14Sand F-1 Gravel E] Sandy Loam E] Ciuy Loom El C|uy [] Adobe F1 Hardpan- E] <br /> TYPE OF INSTALLATION AND SPEC|F|C/\T|ONS, <br /> (No septic tank or cesspool permitted if 200 feet.) <br /> Septic Tank: Distance from nearest weU- '- Distance from foun6ufion- Material------ - <br /> No. ofcompo�menfs---_.��~=---(�opocify--' w���^�--Iize-����. �qui6 �opt�- _ � <br /> °",-"`-0 9''- Distance "°m nearest well -Distanco�from foundation 'Linin� material-------------------------------------- <br /> Size: <br /> -____ <br /> Size' Dama+er--------------------------------------Depth---------------------------------------------------- (A�� <br /> � <br /> Distance from nearest well------------------------------------------------Distance from nearest bui[cl|ng---_.---__._-_- <br /> Distnnm, fnnoanoo+ lot |ine�'--_-.'--.--'-__---' <br />+-~- pogo Pit' Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line`-___.- = <br /> Number ofpits----------------------Lining material----------------------- Diameter-----------------------Deo+�._--__.___-- <br /> � � <br /> ' � <br /> � - Distance from nonnx� we�..� _-D�+o from ,���. ^ <br /> Number of |� ^ --Length of each |i of ��nch.. - ------------------ <br /> Type of <br /> -.---------.'Typoof fi|termaferiaL Depth of filter mate ria <br /> L- <br /> noJelingand/or n*puiringe\:--------- ------ '--------------------------------------------------------------------____.________^ ____________ <br /> _~~~-'.__-..___.-___._--�--__..___.--__-_-----_-__--___.._. "' ____---__-'__-____- <br /> ----------------- ---------------------'-------------------'----------------'�����������������-----------------_���������������_----------------------'' <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> �reby certify that I have prepared this appli flon and that the work will be done in accordance with San Joaquin County <br /> les a re tilations o - he San Joaquin Local Health District. <br /> .es, State <br /> --''--__''''--'-_.'--_-'''_-(Ownmr-anx/or ` <br /> °'�--�"------�_---'---''^---- '''-�-��'-__''''--_- /nle)--------------------------------- ._____._. <br /> �m|an� shnwingv�omf�t |wca�nnofoyotvmlnre|a�*ntoweU,. 6uU6ingm' m|m° mus+ 6o1l�6w�h this application). <br /> FOR DEPARTMENZSE ONLY <br /> - <br /> APPLICATION ACCEPTED B -..`__- DATE-���� ----------- <br /> REVIEWED <br /> ___REV|EWBD BY--------------------------------------------------- DATE---.--.-_.-_--__________. ' <br /> 0U|LD|NG PERMIT ISSUED------------------------------------------------------------------------,_----.- DATE-_.-----.----.-_--__._______ <br /> Alterations and/or recommendations----------------------------------------------- ----------------- ---------------------------------_ ------------------------------------------------------ - <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ----'----''----------'--'--^''----------`—'-------'------''--------'------------' <br /> --------.---------- ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- <br /> ------'----'' -------/'/� -�-------------' ------- <br /> �� ' <br /> PERMIT Nm��0-��''J_�- ISSUED--,----- RN/4L INSPECTION BY: <br /> ''-'_-'___ ' <br /> Date--------------I -. -'?---—-.-_--_-- <br /> 3ANJOukQU|NLOCAL HEALTH DISTRICT <br /> ��� Soufh American Street <br /> ' Stockton, California <br /> es-�--uw v�ow�/am - <br />