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' <br /> �-� <br /> «�o�p <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in -Duplicate) Issued <br /> p ' <br /> is hereby made to the San Joaquin Loco/ Heo|fk District � o permit to construct and install the work herein eacribe6. , <br /> This application ismade incompliance with County Ordinance No. 549JOB ADDRESS AND�OCATION__ /Y /3 ' <br /> -- -- --- <br /> . . <br /> Owner's N | <br /> � ' <br /> ------- ----------­----------- ----------------------------------------------------P__h,*o-6'�64_. -----0- ------ <br /> Installation will serve: Residence e-"Apartment House E] Commercial E] Trailer Court E] Motel F] Other E] <br /> Number of /w/ng un/~s: -/- Number of bedrooms Number of baths .<-' Lot ,bn ------------------- --- <br /> Wafer Supply: Public system ER" Cornmunity system F] Private E] Depth to Water TabloY'd ft. � <br /> Character of soil to m depth of feet: Sand Gravel �n� �m � �oy �m � ��y � 'be <br /> ' e Hu��n I- <br /> ] ^ <br /> Previous Application Made: Yes [-] No grll*�New Consfrucfi n: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: % t <br /> (No septic tank or cesspool permitted if public sewer is available <br /> -- ' -' �� ' <br /> SepticTank: Distance from nou,us� well �-''-'-Distance from foundation--------------------Material '' ''�'-''_-'-'-''- <br /> [] No. ofcomportnent�--_-_-- --S��_''_-._--.._Uquid 6epfh_._--'--(�op�c�y----------------------- � <br /> Disposal Distance from nearest well '_-''_Distance fnom foundation--------------------Distance tonearest lot line'--'--- ' <br /> �� Number of lines_-_---��---.-Length ofeach line_---__---V�6H` of �onck-_--_----- <br /> V <br /> Type �� filter mato�aL'''-''-'-DupH, of filter material----------------- �no+�-.___-'-_---_ U� '� ,0S� : Di,�nce � '��..- _O��m� � noa�� |� <br /> mp� Nu�6e, of p��--�.---.Uning muto�uL S��� D�*�otor.-���,/--Dnoth- ��`�-.'._-_ <br /> Cosspo"|: Distance from nearest well-----------------Distance from foundation--------------------Lining mofu,uL----.--_._ <br /> �] 3izo. [Xomo+e,--------------------------------------Dept h--------------------------------- ���'�--Liquid -'''-'-'---gals. , <br /> Privy: Distance from neu,estweU------'---------------Dist nc° from nearest building------------------------------------------ <br /> Distance to nearest lof <br /> -_--_.-._--._Dist noetonaonos+ |o+ line'''-''--''''----''-__-_----'-_-.-''__-'--'''--'''-''--�-'-' <br /> Remodeling and/or repairing (dn,c,i6e):--------- ---------------------------------------------____------------------------------------------------------------------------------------ <br /> --``--'`--`--'``-`--'--``---------`---`-```--'-`-------'--------------------'------'--' <br /> - ..........--------------------------------------------- ------------------------------------------------------------------------------- ..............--------------------------------------------------------------- <br /> --__-_--------_-.__--___._._------____-____--_-_-__-._-__._'----_.--._-.--.-- <br /> / � <br /> h <br /> ordinances, State law"snd rules and regulations of the San Joaquin Local Health District. <br /> f and/or Contractor) <br /> (Signed) --'-----''-'''''''-'''- <br /> �f -''-_.'''''''__.__--'''--'}�+�i ___-'___�- <br /> ------------- <br /> (Plot plan, showing size of lot, location mfsystem in relation +* wells, bu7kdYngs, etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED 8Y----------------_.. --_--------' DATE.--_�L�..��c.."��.���,�-�_-.. <br /> REVIEWED BY------------------.--------..�y..^�.» ------------------------ ----- DATE---/_._-�.___..�__7- ____ <br /> 8U|LD|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE_'-___----.--.-____.. <br /> Aherwtio°s and/or recommen6u|ions:-------------------------- -------^ ---------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------ ---''--'-''--''''-'---'''--''''-'''--''----''---------'-- <br /> ������������---------------'�����������������----------­-----_--------- ---------------------------'�����----------------------------------'--- <br /> -'---'-'''-''-'---'''---'''--'''-'''''--''''--'''-''''--''''—''''--'''---'--''--'--''-'---'-'- <br /> ----`---``-------`----------````�� --``-----`�-----```- ----```--------````---`----```-------```````-------``-------------`````-------------`---``-----`- '``---------- <br /> ARNAL INSPECTION BY��'- �- -� -�'-- Date--' --�� ---------------------------------- <br /> SAN <br /> ''-'''-''----SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 s=m Arn*,ic°" Street 300 West Oak Sfww+ |sz Sycamore %*=.* o/* worth 'xr' s*w°+ <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />