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� <br /> - APPLICATION FOR SANITATION PERMIT PannKN�� <br /> � <br /> (Complefe inDuplicafe)` Du+o |mmo6���.. <br /> /\ made to the Sun Joaquin Local Hau|fh 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 /> JC�� /�DDRESS L3CAT ~� \�=� �����__________________________________ <br /> Cx~ner, Name-_-------..&._�.--� �:'��.«%.��_----.-------.-.-----------. Phona----_-.----_-- <br /> A6Jnes-------------------------------------------------------------.-.----.-_--.----__.---.-___________._._____.___.____.._________ <br /> Cont,acto,'s Name--- -- - ---_.-_.OW A. -.,---_--.-_.- Phone- - - - ----------------------------------- <br /> Installation will some: Residence [] Apartment House [] Commercial [] Trailer Court [] Motel [] Other <br /> Number ofliving units: J Number ofbedrooms _��' . Number ofbaths ../-- Lot size --------|.. .^Y�'�'~1~ CL.6.w�� ` <br /> \0ate, Supply: Public system [l Community system to [] Depth to Water Tu6ka -------- ft. <br /> Character of soil to a depth of 3 feet: 3on6 [] Gno"o| [] Sandy Loam E] Clay Loam [] Clay [] Adobe ,6pun [] <br /> Previous Application Made: Yes E] No ED --New Construction: Yo, B-750 I-] ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool po,mHfe6 if public sewer is available within 200 feet.) <br /> 3apt|o Tank: Distance from nearest pe|L-----Didonoe from foundation-------------------Material ----------_-__._ <br /> 171 No. of compartments.......------------------Size--------------------------------Liquid 6opfh---------------- ---------Capacity--'_---- <br /> Di,po, | Field: Disfance from nearest wnU-----------------Distance from foundation--------------------Distance to nearest lot line_--_.. <br /> [] Number of lines-----------------------------------Length of each line-----------------------------Width nftrench'-'-_-_'--''-- <br /> Type of filter material-------------------------Depth of filter muto6oL------.]of | length--_-_-_-_'__-- <br /> Pit: Disfonce to nearest well -'''---------Distance from foundation--------------------Distance +o nearest lot line'-'_-.- - <br /> ` 171 Number of pits--------------------Uning material----------------------- Diameter----------------------Depth---------'--.--.-. <br /> Cesspou|: Distance from nearest well ---_--Distance from foundation--------------------Lining motoroL_-._._.-.-__ W� <br /> R Size. Diameter--------------------------------------Dept h----------------------------------------------------Liquid Cnpmcity '�---'----'galc <br /> Privy: Distance from nearest wo|L---. ---------------------Distance from nearest building------11-an. �f~-'...-_-_ <br /> Distance to nearest lot | � 1� __.-_.-'-'_-_________ --~._________ <br /> ��� J~ <br /> Remodeling and/or repairing opc� �-'- <br /> 6r �5���'*�. -����a�). --]�---- ' <br /> ----------------------------- <br />\ '°. <br /> ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ,,,,�d' nces. State laws, and rules and regulations of the San Joaquin Local Health District. <br /> By:....................- -----------------------------------------------------------------------------------------------------------Title)---.-._-__-------_'__ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> BUILDING PERMIT ISSUED--------------------------------------------- ---------- ------------------------------- ---------- DATE'----._-_-.-________ <br /> &lte,mtinnsan6/n, ,ecnmmon6atinno;------.-----------.--------..----.-------_.----____..__.______._.. <br /> --------�/"7-�' --- -----' - ^ ------------ <br /> - <br /> - ��.��.-=-z-����...��-..'�� - '�au' -'- ��-�*��o�'' - <br /> --m����__�-�]��^� --._'_--'_---.�--_--.�---''_---_--_-----_--._-_--l'-_-----_\- <br /> '-'-'-''-'--'''--�''''-''''--'''—''-''''-'''-'''---'--''''—'''-'----'''---'--'-''''-------' <br /> � <br /> �J <br /> FIN/\L INSPECTION BY:--'-- --------------------------------------- Date-------- /l'' -�/-7---��------------------------------------------- <br /> SAN <br /> '-''-----'--'- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> mo South American Street svoWest Oak Street oz Sycamore Street 814 North ''C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M x°~/""a W-z/oo <br />