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� APPLICATION FOR SANITATION PERMIT Permit No. <br /> � <br /> (Complete in Duplicate) / <br /> Date Issued .. - --------------- <br /> / <br /> Applica-�ion is hereby mm6a to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This |icaM is madein compliancewith County Ordinance No. 549 <br /> --- ADDRESS AND -- - ' <br /> Owner's N�_� -- one------------------------------------ <br /> Address '----'--'---'---- <br /> Conr�cror, Name------ .-*����*�u�- ._-.--.-a.. rnone--------------- ----------------- <br /> Installation will serve: Residence F] Apartment~ House El Commercial El Trailer Court I Motel 0 Other <br /> �� <br /> Number of living units. ..��' Number nfbedrooms -------- Number of baths ........ Lot size -------------/ .-.--'�_' <br /> �� <br /> W� Supply; ���� system El Community system [:] FPrivatePrivate �'� �� to Water �6|n ..�.= ft, <br /> Character of soil to u depth of 3 feet: Sand E] Gravel E-] Sandy Loam E] Clay Loam AT Clay�y ] Adobe [] Hardpan E] <br /> ' <br /> Previous �a�m� Ya, � No New Con s���' Ya, � No El <br /> . ',,.__. �� � *w <br /> TYPE Of INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted R public sewer is availablewith| 200 feet.) <br /> Septic Tank: ^ Distance from nearest well-----,7 Distance from foundation------ .-material <br /> No. of compartments------ :?--------------Si ~ 44 _'Uqui6 -------Cap*city- <br /> Disposal Field: Distance from nearest well .-"J !V Distance from foundation---��--------- Distnco to nearest lot line-----/�--------- <br /> Number <br /> _Num6mr of linesLength of line----------------------------- vf �vnch'_��.."_.-.__ <br /> �- _ � � <br /> . <br /> Type of S|h,r moh,r�L -----Depth of filter material------ length--- -____- <br /> Soopoga Pit: Distance to nearest well -----------------Distance from foundation--------------------Distance to nearest lot line.-_.__ <br /> [] Num6v, ofpit,''-'''---Lining mot:6ui-_''_---Sizo: Diameter----------------- -----Depth...... <br /> Distance from nearest well-----------------Distance from founclohon----------------Lining mu+eri*L''-._-.---.-_ \ <br /> F1 Size: Diameter -''''-'''_''-_Depth----------------------------------------------------Liquid Capacity---------------------------- <br /> Privy: Dlsfancu6nm nuun,sfwell-------------------------------------------------Distance from nearest building--__-_-_---- <br /> El Distance to nearest lot line ���'''�----''--''''-'''----------------------- ------------------------------------------------------------'-- <br /> Remode1ingun6/nr repairing (describe):--------------------------------------------------- ------------ -------------------------___--------- ------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------- ........------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------- ----''---'''------'----''-------''---''------'---'----'--'—'------ <br /> +he work will 6odone in accordancewith San Joaquin County <br /> 'ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> in on to wells, buildings. etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot. location of s, _;em ti' <br /> ys em in relafic <br /> FOR DEPARTMENT USE ONLY <br /> 8U|LD|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-._._-_--_----_--_.- <br /> AKermfionuand/or recommendations:----------------- -------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- <br /> ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------- <br /> ------------------------------------------------------------'''-'''-''-'--''--''''--'''--''''-'''''-''-'-''' ---------- ---------------------------------------- <br /> ------------------------------------------------------------------ ''-'''--''-'''---'--'-'''--''''-'''--'`'-'''—'''-'--'--'-- <br /> RNAL INSPECTION BY --'''-''-- Date''// ---''-''-''-'-' -- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /30 South American Street 300 West oak Street /32 Sycamore Street ow worth "C" Street <br /> Stockton, California Lodi, California Manteca, California nam^ California <br /> ` sS-/+-ow x°w"°a vv-2/on <br />