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� APPLICATiON FOR SANITXTION PERMIT Permit No. <br /> (Complete in Duplicate) Dufo | - � ��, <br /> ona6v mu6a to the Son Joaquin Local Health District for o permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> �_ � <br /> JOB ADDRESS �L ���'�' ^~ - r <br /> --�----------'_~_.-------. � <br /> Owner's <br /> Address--------- <br /> sound ---_-------_ .-._-. <br /> Contractor's Name-----------------------' -------�����-----�--------------------------------------____`____.__ p6on9$��.. R7_ <br /> Installation will serve:. Residence WL Apartment House [] Commercial L] Trailer Court [] Motel [] Other [l <br /> Number ofliving units: -/-.. Number ofbedrooms J. Number of baths /iA^ s .. ....................... <br /> Wafer Supply-.' Public 'system E] Communitysystem [-IPriva feX Depth to Wafe, Ta"6| Ato"ff. <br /> Character of,soil to a depth of 3f,66f. Sand E] Gravel S�y Loam Ej Clay Loa [:] Cl ' Hardpan E] <br /> Previous Application Made: Yes E] No IQ New Construction: Yes 0 No <br /> TYPE OF INSTALLATION AND SPEC I IFICATI-ONS-",- <br /> o septic tank or cesspo�l-!p-eIr"miffed-if,�-pu��Iic sewer is available within 200 feet.) <br /> --------------------------------------- <br /> Di* Distance from nearesAw�112 Distance from foundation.--------- -"--.Distance to ne5rest INot line------------- <br /> Type of filter Depth of filter malerial Total length---------------:77�_----------- <br /> A Y IAA-4 p <br /> Cesspool: Disfancejltr� nearest well------------------[:4tance from foundatio- -------------- <br />� U SRiateQ <br /> Privy:: Di�fance from nearest well-------------------------- -------------DIstance from nearest building- <br /> Renoaeling and/or repairing (describe)---------------------------------------------------------- --------------------------- _ ___----------------------------- <br /> ___ ___` --_________ <br /> .---' � --'--_-�'-__-�''-__--_.'''''-_--'-_--'''- ~- � <br /> `~ -]�''---'''-''--- ''--'----'-------------- <br /> I hereby cert y th t I have pr ared this p lication and that the work will b done in accordance with San Joaquin County <br /> ordinances, Sfat klawand Yes a regulafi ns. of the San Jo in Local H.ealt District. <br /> By:-------------------------------------------------------------------------------------- -- --(Title)---t_)_sr <br /> (Plot plan, showing size of lot, location of system in relafion w ali;',buildings, ef can be placed on reverse side). <br /> pOR DEPARTMENT USE ONLY ' <br /> REVIEWED- -''''----'-- ' J:2�� <br /> -- ' <br /> --- <br /> Alterations and/or ,ecnmmondatimnu--- 10�._-_______--__.___---.__-_..__.____.____ <br /> ' ^ <br /> . � . <br /> '- ----''-____--.�-----._-'------.----._-.. ___-_-'-_-.__-_.--.__-__..-__-.____-_. . <br /> ^-'---''------'�'-''-.'''---'--�_''--'''-_''�-)r--'''''_-_'''--''-____.______________._______ <br /> - _. <br /> . ; .. <br /> -'-_'--'-''~_-'--_--''-�--'--''--'''--'-''''-_'-''--'-_.''-'_''''-''--''---'--'--'----''''-_--- ^ <br /> ---------------- ------------------ ------------------------------------------------------ ----''---''----''''''''-''''_''----'''-----'-''''------_- <br /> . <br /> � , <br /> FINAL |NSPECT|[)N' DY�-- ----- Doh,----- ---------------------------------------------- <br /> SAN <br /> .-------------_SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /ao soum American otr°^* 300 West Oak so~"v 132 Sycamore Street ow North ^c'' S*mm � <br /> e" u"". California Lodi, California kx*nte*,. California Trac' California <br />