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APPLICATION FOR SANITATION PERMIT Ro,mK No <br /> � <br /> � Duplicate) <br /> (Complete ' Dufa Issued %Applica';on is hereby made to <br /> o6mnJomquinLoco| HealthDistr|ct6v a permitfo constructand install the work herein described. <br /> This application is mode in compliance with County Ordinance No. 549. ° <br /> Owner'sJOB ADDRESS AND ATION.Au/?, <br /> '`72, <br /> --'' ------ Phone------------------------- <br /> m <br /> ' <br /> Address- <br /> ~ - <br /> ------------- <br /> Contractor's Name -_.]�� -_----'—_--^-----_ Phnm�" � <br /> Installationw0serve, Residence �� Apartment House Commercial Trailer.Court E] Motel E-] Other E] <br /> Number ufliving units: vy- . 'um6er of bedrooms Z;�-Num6o, ofbaths Lot size ---- //.�--..�a-r-A~.0�_.--------------- <br /> l <br /> Water Supply: Public system C6onmunHY system 0 Private g Oepfh to Water Table ft <br /> Character of soil to a depth of feet: Sand [] Gravel E] Sandy LoamJj��40oy�Loum Ea Clay [] Adobe Hardpan [] <br /> Previous Application Made: Yes [] lNo JA_ New Construction: Yes 5�,No <br /> TYPE OF INSTALLATION AND SPE'C' IFICATIONS: <br /> (No septic tank or cesspool pe.imifted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__J�_____Disfance from foundafion--.-/A.........M f I <br /> Disposal Field: Distance from nearest well_.._4/P.a.......Distance from foundation---J_.*----------Distance to nearest lot line--- ­el­ <br /> Seepage Pit: Distance.-to nearest well----------------------Distance from foundation -----------Distance to nearest lot line----------------- <br /> Cesspool: Distance from rearest well--------- <br /> Privy: Distance from nearest well--------------------------------------------------Distance from.nearest building--.-_---._______ <br /> El ' Distance to nearest |of1ioe- - ------------------------ --------:--_.--''­ <br /> Remodeling and/or repairing (6asz|be):------------------------- ------------ ------ ---------------------------------- _.'-'______-__'_____'`_ � <br /> ---------------------------------------------------------- <br /> '--------------------------------------------------------------------------------------------------------------------------------------------------------------------:----------------------------------------------------- <br /> '-'-'-_-_---------------------------------------------------------------------------------------------------------------------------------------------------- ~^ <br /> , ` <br /> '--'_-'------'__-''-.'---_.'-'-''-_''__''-_.----''__.'-_.'-_-''-'--_-'_-'-----'-''--__--'^ <br /> I hereby-certify f hat I have prepared this applicaf ion and that-the work will be done in accordance with San Joaquin County <br /> ordinances. State law <br /> and rulesand regulations of Ae San Joaquin Local Health District. <br /> (Signed)-- ------.. and/or I <br /> -----------------------Title>-- -------------------- - <br /> (Plot plan^ s�owmg size of lot, location of system in relation to wells, buildings, efc.. can be ,laced on reverse side). <br /> -FOR DEPARTMENT USE ONLY <br /> AlterationsAPPLICATION ACCEPTED BY' --------- ------- -----------------------------------------r------------------------------ DATEQS*% <br /> and/or, recommendations:--------------- --------------------- -''---''__.'-------------------------------------�_.'-_'-'-'_--_.'---' <br /> ' <br /> ........... ''------'''_--'''-''''-'--'--''--'''�-'--,'---'�_-'--'''-'----'---''--''--_'-----.'_-. <br /> , ` <br /> -'---''----_''--''''--------- ----------------------------------- - ------------------------------------------------------------------------ -------------------''-'_-_.'-- <br /> � <br /> ------------------------------------ --------------------------- ------- --------------------------------------------`'-'''''-''''------------------------------------------------------------------------ <br /> --'--- ---------------- ------ '''-''''-1i'--- --------------------------------------- ..........._ ........___................ ____________ <br /> FINAL INSPECTION BY:---'' '--- - 'Date......... <br /> < SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> /30 south America" Street 30D West Oak street132 SycamoreSfreet m+ North "C" Street <br /> Stockton, California California ��i. o°mv�}o ' xxwom" . �*(n�m|m Tm�� �a|n*�� <br />