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AjPP[]C��T���� FOR SANITATION PERMITPermit No. ------ . <br /> (Complete in Duplicafel Date IssuedApplication <br /> construct � i �U � �� ��» ��� <br /> \ for permit� to <br /> This application is made in compliance with County Orclinani:54o. 549. <br /> JOB ADDRESS AND L,,.CATION--- Phone-- <br /> Installation will serve: Residence Apartment House [] Commercial [] Trailer Court Cj Motel C] Other E] <br /> Number of living units- ------- Number of bedroornsc-,-2—Number of baths Lot size ---/ ------------- <br /> Water Supply: Public system Community system El Private E] Depth to Wafer Tablem-o 4'ft. <br /> Character of soil to a depth of 3 feet:, Sand [] Gravel E] Sandy Loam [I Clay Loam .Ll Clay 0 Aclo>�K�Hardpan 0 <br /> Previous Application Made: Yes El N�o�New Construction: Ye No E] <br /> k I <br /> TYPE OF INSTALLATION AND SPECIFICA IONS: ilable within 200 feet.) <br /> (No septic tank or cesspool permitted if public sewer is ava <br /> Septic Tank: Distance from nea�esf wellOr-01 ;quid depf__ ty------ <br /> Tr <br /> of compartm <br />` \ Distance from f"vn6uf| ' Distance f nearest lot <br /> Diqposa-tFi6lcl Distance from nearest <br /> Len <br /> / vru/ /m.y".ot of ��ematerial / -------------------_ <br /> Saapo Pit: Distance to nearest well <br /> Number of <br /> its <br /> TXY <br /> na� well Distance 6nm foumJuf�n -_-�i�ning mn+amu/-__._-'____-_ N' D�t ncn +n�m nou wo _--'-- -'''-- i�,~«�Pqpc ~ � Uou�6 Cupuc�y __go <br /> 6�o� D�mv+nc--'__.---__.--'-Dup+h____.�_--_-._-_-._.. . '--..__.._�. �� <br /> Distance from neureo ��|�i��._--__�_��-'__- <br /> � p,�y � Distance from nearestv�|---''''-------''''''--- � __________ �k <br /> Distance to nearest lot |inu -'''''''--_____-____..__._---.-------------------------- <br /> Remodeling <br /> - <br /> � L� '''---'''' <br /> / ~e"od~..g and/orrepairing_- (describe) � <br /> ^ ___._�--- <br /> `� -----'------'-----''''--------------'''� &n n��n1u �Mh �m Joaquin County <br /> -------'--'-'''---� 6 t�m+ f6a ��r �� 6u done accordance San' f� / h ,�� this ��r ". .^~ ~. _.. _-`_ ' <br /> . I hereby cerfify <br /> ordinances, Slat 4anddlesod regulations of the San Joaquin Local Health District. <br /> , f_ -------------------------------------------------- <br /> jPlot plan, showing Sig of lot, location of system in relation to wells, 6uildings, etc., can be placed or reverse si e). <br /> FOR DEPARTMENT USE ONLY <br /> APPLI <br /> � REVIEWED BY . - —'' <br /> , ------------------------ <br /> ___,-__-.-�--�—'--'—�'- --'------m--� � / <br /> -----_._._'-_-------. -_--._---.----_' ..+..----�_------_-_--_-�-'�. ` <br /> ` <br /> F|N/\L INSPECTION BY�---�~�.—.~Y__-../c'_-���---� Du+n--�'~���°c.v��------'_----__. / <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> m� w"�� ��' s�°° <br /> /am South American Street mmvv"� O" s�°° /ox Sycamore s+°° . ' <br /> »xa| o"|/f","/" w^"�=o. c°|e","�" T= California <br /> "v. c" . <br /> �""�o, California ' <br /> Fs-9--2w o'n/ n*./sa6 v*u/oo , ( <br />