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APPLICATION FOR SANITATION PERMIT Permit No. <br /> ' |� Duplicate)(Complete- - '��-' Duto |omo6 -_/����-I <br /> Application is hereby made to the San Joaquin Local Health Disfrict for a permit to construct and install the work herein <br /> This application is made in compliance with County Ordinance No. 549. 00g- -370-al 14 <br /> 4-41 f4;w 104d <br /> 10 <br /> JOB SS AU&WCAT e <br /> Cont�cto�s N�me .__.___-_----_---'_-_-----._.--����_-- Phune----------------------------------- <br /> \nsfailation. will serve: Residence .� Apartment House �] Commercial [] Trailer C�� � u� Other [] <br /> � � � <br /> Nu�6m, of |�vingun�i�� -�-, Num6o, of6��ronm� -.�' Nvm6erof ��+hs ..�-' Lot size ------------------------------------- <br /> Wafer Supply: Public system E] Community system El PrivateA Depth to Water Table 46. ft. ' <br /> Character of *oil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam MM Clay JM Adobe E] Hardpan � <br /> Previous Application Mad*: Yes E] No X New Construction: Yea ;4 No [i FHA/VA. Yes [] No El <br /> TYPE OpINSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank pr'ce,spoo| permitted ifpublic sewer Yoavailable within 200fow+.) <br /> .| <br /> Septic <br /> Tank: Distance from neare,+ weU-'r=-----Dista <br /> -Di,+o frpm fQundafion-Z <br /> q---------Mafe,iaI__47t <br /> 4��' -.- <br /> Nv. ofcompu*mun|s- �X---..S|�o-' ����� ------------------ <br /> A <br /> ��- � �--- <br /> � �~ <br /> Disposal Field-. Ditunce from nearest wp7P � nce f foundation Distance to nearest | ; S~~ �-410� �L�ngH` c� eu�c� �no`.'- ��.� Width Num6er of |inL__ <br /> Type of filter material Depth �f �|te, ^~ <br /> mo+rr�o|������������To+o| length-J�X��-_-����_��---' <br /> Soepoge Pit: Distance to nur ,ey well-------------- from foundation-------------------Distance to nearest lot line----.- <br /> [l Number ofpits----------------------Lining material-----------------------Size: Diameter------------- ----�-Duo|h--------- ----------------------- <br /> Cesspool: Distance from nearest veU--------=,­.Dis+mncn from foundation-------------------- mu+a,iaL''�'-���-��-'�-- <br /> � F71 Size. Diamefec---��-___� -- --Doofh------'_------_-_�qui6Capudt�'_-_--_.ga|s <br /> ! � ^ <br /> � Privy- Distance fnom/neures well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> El Distance +onearest lot line----------1-----------------------------------------------------------__--_--.__---_—'--_— \� <br /> komo6eing am6/pr n,Fm�hng (6auzi���'--.'_^~�'/--''-''--''-_.''-_-''----_-�-'_-''_-__.__-'-�---_-,--. <br /> _-.'-_.----___--'----__'-__.''-_.''--'-__'--.-'__.-'-_-'''__.-_.-'-_--'�_''--'-'''-'---_----. <br /> _---.---------'---------__--.--_-__----_._'-'__-__.-----__--------'-_---.-------_---.---- <br /> .--_—_--_____._-^-..__-._-_-__-_.-__.--__--__--__--___-----__.-__.--.—.----_--. <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County F <br /> ordinances, S laws, and rules �nd regulations of the San Joaquin Local Health District. <br /> ' <br /> (Signed '� ------------------------------------------- -pr Contractor). <br /> By:-------------------------------'�'�-'------_--._-_---'__-___-.-_--�T��L-._-.---_--_--------.. <br /> (Plot plan, showing size of lot, location of system in relation to wells, 6uY|67ngs, etc., can be placed on reverse side). <br /> � . FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED DY---- ------------------------------------------------------------ DATE.---------- --------- -----.. <br /> REV|EVVBJ BY-------------------------------- ---------_----_-----_-_---.- DATE------------------- ---__-._-_--. <br /> BU|LD|NG PERMIT ISSUED-------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----------------------------------- ---------------------------------------------- --------------------------------------------------------------------------- <br /> --------------------'-------------------------------'-----��������������������������_����'���--���������������� <br /> / - <br /> --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> - <br /> ------------------------------------ ------------------------------------------------------------------------- -------------------------------------------------------------------------- ----------------______ <br /> --_------_------._-.__-----------._.---_-'_-------_-_--------.------._.. <br /> FINAL INSPECTION BY:-' -''-'-_.- D�h�'�/ -�� � .-'-'-'''-'--'-'--''— <br /> ' SAN JCAQUIN LOCAL HEALTH DISTRICT <br /> / /30 south American street 300 West Oak Street 132 Sycarno= Street ow North "C" Street <br /> Stockton, California '� Lod|, California Manteca, California Trac'. California <br />