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~� <br /> APPLICATION FOR SANITATION PERMIT <br /> � ~ <br /> , <br /> (Complete in Duplicate) � Ilk ^ <br /> Application is hereby made to the San <br /> This application is made in compliance with COU ty Ordinan 54.9 a.V I <br /> JOB ADDRESS ANDlOgATION---- <br /> Addres <br /> Contractor's Name-------- (�� 9 <br /> Installation will serve: Residence Apartment House L] Commercial Trailer Court E-] Mofel L] Other L] <br /> Number of living units: <br /> Lot size <br /> ' Number of bedrooms a Number of baths " -------------------------- <br /> WaterIf . <br /> Suooly": Public system Community system [1 Private F1 <br /> Character of soil to a depth ofTfeef: <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is availabk within 200 feet.) <br /> Distance from nearest welr4�- --Distance fro f iinclation--- KA t <br /> Septic Tank: <br /> � ' Distancefrom nearest well_-------------------------------------------------Distance from nearest building------------.-- - <br /> [] Distance to nearest lot line___._�_---_-___.--. <br /> i Soupuge Pit: Distance to nearest we|L-''___''-Distanco from foundation Distance to nearest lot line' <br /> / El Number_ of p.. <br /> ^ . from nearest <br /> '-~ Distance-- fro'—m --- -....... .. .~..... <br /> Nvmbo, of | ' ''' Lnno+' of each line--Z, Width of +mn <br /> ' - <br /> --'----' <br /> Type of filter mo+eroL-/�J�.*��' Uoo+ of G|+ar mn+o�aL._l`���_. ~ '~ <br /> Ramodeli�ng and/or repairing (describe):----------------------------------------------------- <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 <br /> ordinances, State laws. and rul'es and' regulations of the San Joaquin Local Health District. <br /> Kq*f plmns�-A6owiny size nflotN8���n �foyoh^m ��e�f�nhGweU, buildings, efc. mus be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> BUILDING" PERMIT" ISSUED------------------------------------------------------------------------------------------------------ DATE-.--_-__-___.._______.._ . <br /> ` ommend ''' '' '' ---___-_ <br /> -_._,�-��f�=-,-^-__^*...e��~-_�-�u_..z�ac^«��mc�._--_c^�,�*��..��-__--��^...�.-^..-5v.. <br /> _''__---'-_-'__.'-__--''___'---__'---�--8-______._---____.- <br /> _____--__..__ <br /> .--__..' .-= <br /> ---------'---------'-----------'_--------'_---------_____-----___�����-----------'--__-----------------_______------'----_------------'---------'--------------- <br /> ___._-____-__-._ <br /> ----------- <br /> PERMIT N -?.- ISSUED-- ]u1o) FINAL INSPECTION BY:_ __._.. ' <br /> --------------- <br /> Date <br /> '-_ <br /> oo+e-.-_--''�� .. --��-_--------' <br /> SANJOAQWIN LOCAL HEALTH DISTRICT - <br /> 130 South American Street <br /> � <br /> Stockton, California <br /> ES-9-2M 9-50 Wc1639 � <br />