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\ <br /> /~< <br /> APPLICATION FOR SANITATION PERMIT Permit No <br /> � Duplicate) <br /> (CompleteDate in <br /> Application is hereby madg Afofhe/Sa�nJoa Local Health District for a permitjpgonA�y� install the work herein described. <br /> m/s op9.c*`w= ., """"° in c""pva"~" if & � <br /> /-.,( e I <br /> - , �__- _-_.._ _ --------- <br /> Contractor's <br /> I <br /> Conf�cfors N _ '— --------------------- ----------------- Phona----------------------------------- <br /> Installation <br /> --'-_.' <br /> '-_''— <br /> |n�uUution *U| mon.w: Residenceorfmonf House [� Commercial [] Trailer Court [ Motel 0 [Hnar .^ <br /> � <br /> V- / <br /> Number of |i�ng units: -�y-.. Number ofbedrooms -,~~Number of baths -^_ Lot ,be ------ ------------------------ <br /> .m� ' <br /> Water Supply: Public system El Community system [] ��� _ Depth toW�* Table �� ft <br /> Character of soil to a depth� �� �� Sand G �y Loam p� Clay Loam I-] Clay E] ��o� Hardpan <br /> � <br /> — _ �� <br /> Previous Application Mad*: Yes �����' `�X <br /> No � ���. �s � No�� ..- . <br /> TYPE Of INSTALLATION AND SPECIFICATIONS: <br /> (No septic � available within feet.) <br /> Tunk� Distance from nearest �ell . --'0ion ../.� <br /> Uquid6v�h_-� �^K-..0�pX3 Nuofcompa,� enf�- - � <br /> �ara� U P | /0�Dl | Field: Distance from <br /> Number of lines Length of each |i of trench ''_'- <br /> .` <br /> ' <br /> Tvpe of filter material-- Jr_r?�4Dupth of fi|+vr material - /?--.-�o+al length-.-_ � l------- <br /> SoepogoDistance <br /> �t D�t nc� to n�ona� woU--_---��l�uno, from fvun�u�nn_-___�-D�+ novfu nearest |ino`--._- <br /> El Number of p�ts.'�''-'''-Lining material----------------------- Diameter------------------------Depth------------------------- - <br /> Ca0000 : D�stnnce irom nearest well-----------------Distance from foundation--------------------Lining material ---------_- <br /> [1 Size; Diameter'_'''-''' --------------Dept h-'''''��-__-''--''''--Liquid Capacity--------------------------- _ <br /> Privy: Distance from nearest well------------------------------------------------- ist ncu from nearest 6ui16ing-__---___-_-- <br /> [� [Vstanoe +oneqn,st |o+ |inv.������--'''---'''''_----'-_'-_.-''_�-'_-----''---______________ <br /> Romo6oing on repairing ______.__._ n� <br /> ._._-_.._--__---'-_-------_'__-___-_-_---___--._-_—_.___—.__-----___--'__ - <br /> ._--__.--___--._._.--_-..�_-_--____--.'-----_---_----_-._-----------.—'_____.'-'''---''_-'-'' <br /> ------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------prI hereby certify that I have epared this this and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State lawst and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-- -----------------------------------.(OwneramJ/*, Contractor) <br /> By:------___---------------------------...... -------------------------------------------------------------------------------------(7it|o)---------------------------------------------------------------- ' <br /> (Plot plan, showing size m� �t location of oy�nnx �n�r�|a��n f� wells, 6w�6ingo. oh:, ��n 6� ���e6 �n reverse �dmL .^ <br /> . / <br /> FOR DEPARTMENT USE ONLY <br /> � <br /> APPLICATION ACCEPTED 8Y. <br /> RB/|E\�E� DY---------.----�------.. -.-��-- u*|�-..'��..~~..'��.�~�x-��.-----.. <br /> � � r �� <br /> BUILDING PERMIT ISSUED------------------------------------- .e��^��..����$----------------. DATE----------- <br /> and/or recommendations:-------- ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------- '---------'-------------------'----'-------'--------'--'—'--' <br /> _------'-_--_-'--'-''-_-'''-_-''-'-'''--'''-'''''''-__'''�----''--'---''-----''-'-_--'__.-__--- <br />. ._._-_--'_---__------_------'_--_----_-------.__-----._--__-----_.__. <br /> ------__---_---_--------_____--- _ ---_�������---'_-------__----__--_-----___-----______---___-----__---_------ <br /> � <br /> � / _- � ~^ ~=.� <br /> RN/\L INSPECTION 0Y�----"���.�,°�����x�°������� o*u,----..+'^---�.----------------. <br /> � � <br /> SAN JOAQU/N LOCAL HEALTH DISTRICT <br /> 130 s=m American sr,"o+ soo w°"t Oak s*""t /vu Sycamore Stmw* u/+ w"*k ''c^ s+,=+ <br /> Stockton. California Lodi, California Manteca, California Tracy, California <br />