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- FOR OWFFC USE-. <br /> V' �y ' APPLICATIONFOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) ~ <br /> Dmfm Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Oroinance No. 549. <br /> ------- <br /> Installation will serve: Residence M' Apartment House f-1 Commercial [] Trailer Court [] Motel 0 Other [] <br /> Number ofliving units: -I-' Number nfbedrooms 'J. Number of baths .1..-. Lot size ................-------------------- <br /> Water Supply: Public qainm [I] Community system F1 Private &~"bop`h -roWater Table 3,7 ft. <br /> Character of soil to w depth of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam [] Clay [] Adobe[ff~~Hu*dpwn <br /> Previous Application KAwdm: (if yes,6cite------------------ ) NnUK~NawConstruction: Yes p3~No [] FHA/VA' Yes F] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:��� ww��w tank �r ��us -- <br /> ( ��wJ permitted public is����wr mvaUm�|wvr1f��m ��� feet.), ' ' <br /> Se Tank: ^S�� Distance10 - <br /> Disposal Fio|J� Distance from nearest *m|L�F.!�--'Distance from foundation-'ee----u/wuncetonearest mt -.-_. <br /> Number of lines--'��-----'__'Length of each line--2-��..-----VVidth of +ronch--��'5.'.----...- <br /> -- Type of filter mu�m,;aL-.�q.!�/�.-..Depth of fi|tn, mufe,iuL-/Er.-+---Tofu| length--..�,k\0..-------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----..............Distance to nearest lot line----------------- <br /> 0 Number ofpits----------------------Lining material _-_ -----------Size: Diameter-----------------------Depth.--_-___-' <br /> : Distance from nearest well----------------- from foundation-''''-'-Lining material-------------------------- <br /> [] 38e: Diameter----___--'-Deo+h,-------------------------------------------------Liquid Capacity..............-------------gals. <br /> Privy: Distance from uou . w=U '-'-n-'---'" '----Cxstanca from nearest build Gng------------------------------------------ <br /> 11 <br /> -''---__.__.-'--11 Distance tonearest lot line---_--_--_- ----------------------------------------------------------------------_---.--- � <br /> Rnmo6eJ|ng and/or repairing (clmschbe):-'�-__.�-Z-.-_-_-_.___..__---'-_-_-.--._-----..___.._.__-''..__. <br /> -__--__.------'-__----._-___-_-_-�___.-'_.--.'-__.-__---''_-----__.-''---'--'----'__-' <br /> � -----------------------------------_------'-----------------'------'--------------------------_'�� -____-----------'--------------'----------------------------------------------------------'---------- <br /> -----------------------__------'__----------------'_�- � <br /> 1 ~~^~' r that have prepared this application and that the work w3withi be done in accordance * � San County <br /> ordinances, <br /> ~ ^~^� ^ km of i Health C�sf66'' . ` (- <br /> - , <br /> -_ --------------------------------------------------- .and/or Contractor) <br /> ' <br /> =r^---''---'----- -' ---'-------'----°''-'---'--------------- <br /> �� u�n. ��� �� � l� ���� s �m � ��� fowells, buildings, etc., can bwplaced wmreverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ",,"C"..`'" ACCEPTED ".------------~+ �-------------------------------------------- DATE-.--,5-'=__----'------------ <br /> REV|GWED BY------------------------------------------------------------------------------------------------------------------------------ DATE_--.--.-''__-_--.--__ <br /> BUiLD|N£' PERM|T ISSUED-------------------------------------------- --------------- -------------------------------------- u,wE---_--_-_-------''-'--'- <br /> Altermfionumn6/nr '''-'--'-'''-'''-'''-------------------------------------------------------------------------------'-_'-----' <br /> --'���� - - ' ------- -'--6��---- ---' '---'----------''----------'' <br /> .-.- ����--_.~�~�����--_-._-_----.--.-_---__--' <br /> --'--'---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ <br /> ----------------------------- --- ......... ------------ ---------- ------------------------------------'''-'''---'--'''—''--''-'-''--'--'-''-''---'--'- <br /> RNAL INSPECTION BY:- :;��---------------------------------- D,t,.,5�714�5--'_----.-.-_---._'' <br /> SAN JOAQO|N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> stGCkmm'xa/w"rnia Lodi,California Manteca,California Tracy,California <br /> Eo 9 ncv/ucn v'op um o^az ^rL^s <br />