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� <br /> APPLICATION FOR SANITATION P����T Permit <br /> - <br /> PERMIT <br /> (Complete inOuplicate) ' <br /> Dote Issued -' <br /> /- 17 A <br /> made San Joaquin Local Health District for a permit to construct and i nsfall the work herein lescribo. <br /> This application is made in complian e with County OrdL'iance No. 5499. a, <br /> --------- <br /> Installation "ill serve; Residence rtment House E] Commercial 0 Trailer Court 0 Motel 0 Other [:] <br /> Number ofliving units: j-. Number ofbedrooms 4- Number pfbo+h'»4�~ Lot size -. .----------- <br /> Wafer Supply: Public system [e-c"mmunity system E] Private [] Depth to Water Table 5.-pt. <br />. <br /> Character of soil toudepth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam El Clay El Adobe 0--,Hardpan E] <br /> Previous Application Made: Yes [] No EJ°~'Nnw Construction: You UR--No E] ~_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> /NosepHc tank or cesspool permitted ifspu6lic <br /> Septic Tank: Distance from jO <br /> 161.... Capacity <br /> " <br /> ~ ---1 <br /> Disposal Field- Di,+on�n from nearest .�| -A �.. Diuuc � oundo+- � - Di�+nnce tn no�,o,t |ofl/na-------- <br /> C <br /> - <br /> C �Leng+h of each line .���� ----- <br /> Type <br /> ��--.-Width of +mnch-.z.Num6ur o{ lines - - <br /> TypoofC+vrmutorI -..Dopth of filter material -/.x..........Total <br /> � <br /> |ong+6 <br /> "- � <br /> � D�+mvu, +o ne�����[|�c�3�|Seo . Distance to nearest well:,/ <br /> �]�� <br /> Number of muh,��| -3ize: Diameto --------Depth ---------------------------- <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material -----_- <br /> r7l Size: Diameter-------------------------------------- ''-''''--'''-''''-'''--Uqui6 Capacity-----------------------------ouks, <br /> Privy: Distance from nearest well-------------------------------------------------- from nearest building---.--.-.__----� <br /> ElDistance +vnearest lot line`''-''---''''-'''--'-''--.'-_''-_-��____.___.________________ <br /> Remo6e|ing and/or repairing (describe) 4----------.- __-- ---------------- ------------------------------------ --_-..__.__._________ \\ <br /> __.'--___.'--.'--'_-'-_''_-'-__-__-'-__.--_'---''-_.'___'__.''-_''_-'-_-_--'__.-----''---'- . <br /> ._----_-_---_-___---__.-___--'_._------..__.___-___.-__-.-._--._-___--_----_- <br /> I hereby r i y f I have prepared t I application andAhat the work will be done in accordance with San Joaquin County <br /> ordinances, S +e laws, nd r d regulatio of the. Sarploaquin Local Health Distr1cf. <br /> (Signed)..........T------------------------------------------------------------- <br /> ~' \ � <br /> (Plot plan, �o�� �� � k� ��� � � <br /> FOR DEPARTMENT USVONLY <br /> REVIEWED 8Y_--__.--_.-�=�--------------__-____________ ~ <br /> --------------- <br /> BUILDING PERMIT ISSUED'-_-'''-'''-_''----'-_'''�__-'''---'-''-'''-' DATE''' k^----------------------------------------------- <br /> Alterations <br /> -''-'_-'_'�________Altorations and/or recommendations:—-------- --------------------------------------------------------------------- <br /> .. - L_-.---'1^. -----------_----.----_--------'----------'--'''^-'-- <br /> -��-1 -�^�- -�--''���''-/-� '��~'� ' �` ____ _____ _------------------------------------ <br /> ._____ . __ __ - <br /> ---'------------------------ - <br /> , <br /> FINAL INSPECTDuw^--------u-`^z----.---------------------------------- <br /> /om ~--~�- si ur�LOCAL HEALTH DISTRICT " <br /> /30 South American Street 300 West Oak Street /32 Sycamore Street 814 North "C" Street <br /> oto"kfv . California Lod', California w"^te"°. California n*m^ California <br /> ES-9-2 w n°.i"°d W-2 100 ^' <br />