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mRomo, U51E <br /> ^~ <br /> }('/�u' « N FOR SANITATION PERMIT Permit No. <br /> � %�u��� <br /> (Complete- --- Date Issued <br /> Application is hereby made to the Soo Joaquin Local Health District for permit to construct and install the work herein described. <br /> This application is made in complianc ounty Ordinance No. 549. <br /> ------------------------------------------------------------------------------------------ <br /> Owner's Name---- A <br /> A66 <br /> Contractor's Name.......... =°- --------c...... <br /> �2--�. <br /> --------------------------------------------- --------------------............................ Phone.................................. <br /> |nsfallefionwill serve: Residence [�r'ApartmentHouse E] Commercial O Trailer Court [:] Motel [] Other E) <br /> Number cfliving units: A-. Number ofbedrooms ..3 Number -]- Lot size _ �°����^........................ <br /> Water Supply; Public system E] Community system El Private /9-'OD'epth to Water Table X0!__ ff. ~ ' <br /> Chm,mm|wr of soil to w depth of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam OT~-61uy [] Adobe Hardpan [] <br /> Previous Application K4adm; Ufyes,date-------- ----) No F"'New Construction: Yes R~ No [] FHA/VA-. Yes [I No WR-- <br /> TYPE OPINSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S~p6�c�~T-a�nk; Distance from nearest well 4b-A- ..Distance from 1 .......Material-_/ p-, <br /> No. ofcompartments---------- ----S � Lild � . � Cu <br /> paci+y--'��.-.�=' <br /> / <br /> v � <br /> � <br /> Di,pn,u| Field: D|,funvm from nearest weU.,S__0------Distance from founJo+| / Distance to nearest lot line'-^........... <br /> ' <br /> 2rNumbe �� ����`�� ~-� <br /> Type of filter --..Dopt6 of filter mmtnriuL-�����----Total length--- <br /> -Y_�5�--x^- <br /> Or3mopugo Pit: Distance to nooroo well-1-06 -/#. ........Distance tnnearest lot line_�97 <br /> -. <br /> ,- <br /> �» <br /> U^ Number of pits- .----.Un|ng ,no�er�uL.,' -Sizo. Diameter-3��'---_ ---� <br /> Depth ��^----' ` <br /> Cesspool: Oiot,om, from nearest *mU-..--'_-'D|s+unce6n,n foundation------------------Lining material ------_.----.. <br /> 11 Size: Diameter-------------------------------------- ----------------------------------------------------Liquid Capacity............................gals. - <br /> Privy: Distance from nnuroo well------------- ''''--'''-''--------Distance from nearest building.'-''---'-'-_'-_-- <br /> [] D&+unce'ho neonsf |o+ |ine-------_-------__.._____'_._--_-__._----------.- <br /> � ` <br /> Komn6��g and/or repairing (describe): <br /> ------------------------------------------------'-'- .,'`,_-~--------------------------------------- -------------------------------------------------------------------------------------------------- <br /> '--'--- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------,-__...-_-..___-----_--.._____-__------- <br /> | hereby certify that y6mveU <br /> ordinances, t+�+~ laws, 6 rules °~�' ' ' ill �� i�� accordance ��-h S- Joaquin County-' � <br /> regulations of the San Joaquin Local Health District. <br /> (Signed)- ..____'_.___-_--_. and/or � <br /> 0y:- '''---'(Title)----------------------------------------------- ---------------- <br /> (Plot plan. showing size of lot, location of system i relafion to wells, buildings, efc., can be placed on reverse side). <br /> ' - <br /> ,�RILAENT USE ONLY <br /> Altnrwtionsand/orrecommendations-------------------------------------- ------------------------------------------------------_'.._-_--_--_._-_--- ' <br /> ----------- _ ����'�����_���'��'���_ <br /> ������^'�--���' -'---- "~~`'----�7 '-''----~~---''----'-~---'-''-------''------ <br /> --''-_'-'��--''--'* _'-'-^''---'''--'- --------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------_-.`_---. __-_--.--._--.-_----._--__-._---- <br /> HNAL INSPECTION Duto-'�����.�6��������~=--'--'-'''- <br /> ' ~ �� �~��--� /-- <br /> m~ SAM ����U|N LOCAL HEALTH DISTRICT = <br /> ,nwSouth American Street x*uWest Oak Street 124 Sycamore Street ov5West*,oStreet <br /> Stockton,California Lodi,California Manteca,California rra"v.Caofomia <br /> "S v ""°""" °'v° nw a'*/ m°° <br /> 7C, <br />