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vr <br /> APPLICATION FOR SANITATION PERM[[ PonnN No. ..�]��_�..- <br /> �� Duplicate) ^ ' <br /> (Complete- - '—` Date Issued <br /> �Y <br /> Application is hereby made to the San Joaquin Local Health District for upermit toconstruct and install the work herein described. <br /> Th|sopplicaflori is mo6n in compliance with County Ordinance No. 549. <br /> /^ � / w� (� � <br /> JOB ADDRESS /\NO LOCATION ����-------- -- -.--=!/---'��---..!�. . <br /> nor', Name----------------------- ---//+-�--.^/ ---------------------------------------- Phonm.. ._ <br /> �� <br /> Address- --'---'-'--------`--------- ------------------------------ ------------`-'---'-----'-----` <br /> Contractor's Nome-.--_------_-- _-_/' >------------------- phooe---.--__.___ <br /> Installation will ��- �s|'�� � A��� H�� � �m��o| � Trailer Court [] Motel L] Other � <br /> Number ofliving units: _1-- Number of6oJmvm- S- Number of baths X= Lot size ------ ./.71_-_---_ <br /> Wafer Supply: Public oy,f,mx Community system El Private 17-1 Depth to Water Table --- ft <br /> Character of onU to m depth of 3 feet: Sand L] Gmwa| [] Sandy Loom El Clay Loam [I [1my El Adobe Hardpan [] <br /> P,o°|wu, Application Made: Yo,x No E] New Construction: Yes X No E] FHA/VA. Ye, [] No El <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank o,'cwopop| permitted |fpu6riosewer isavailable witkin200f=mt) <br /> ~�~~� <br /> Septic Tank- D�o+onco from nearest v°U.�����.-Distance from foundation-'.°~�---K4o | <br /> xNo. of compartments------2-_----.Size-' ---Liquid 6epfh--..;�------------Capacity---~Yr.a-.-- <br /> D | Field; ^ Distance �o U �o fu d <br /> Number oLength <br /> ' <br /> of h | �k�� , f | <br /> � r.. � | length <br /> � ,Tvpo of filter mo+eriuL ne� p+h of filter muferl*L--'[ [ <br /> sPit: Distance to noormxt � 11 . .Ditu f on6�t�on to nearest lot | <br /> - � . <br /> ' I Number nf pi+s-_- /---.Lining motn,io|./ � ��-3|ze: Diame+er-'��,� --------------- <br /> Cesspool. <br /> - <br /> - <br /> CessLDistance [} <br /> D�t ncn ��m ne^na� *aU�--_-.Di��ncefmm foundation m�fe�oL--.----.--_- <br /> Gze: Diameter.''---'''--''-_---Dept k'-'''---'-'''-''''''-_''Liquid Capacity----------------------------gals. <br /> Privy: ,� Distance from nearest we|L--------- -----.Distance from nearest building------------------------------------------ <br /> Distance to <br /> -.---------_-.-Dbt ncefo nearest lot -~-------- ��---_-_-_---_--_-.-_---_---.-.------.- <br /> ' - ' -. <br /> . ^ <br /> Homodu�m] and/or repairing �e,cr�u)�''_�''--'��--�.'-�"---------------------------------------------'- --------------- _- ----------------------------------- <br /> -------------------------------------------------------------------------------------------------------- <br /> -_--.__.--__.-__--___-___._..___----_ -___...__''_-�-_-.---_.__.._--__--.--. <br /> -���''������''�''�������'''�'����.�������.'''���'�����------.--'------.'---------'�������-------------'----------'---'---'''---- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State 1, ws. and rules and regulations ,of the San Joaquin Local Health District. <br /> p�neu/_-�r���u��1���,«-�n��--mg �� ---------.----------------.�uwnwr and/or �~on�a��or <br /> By:'----------------------'��-----------'---''�'-�----'--'OqHeL----------'-----'-----'- <br /> (P1of plan, showing size Of lot, location of system in relation <br /> + |6. 6u||J|ngo, mfm, placed � <br /> can 6e � ue6 on reverse side). <br /> � . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED QY----------------------------------------------------------------- ..-,-.---------------------- DATE------------------------------------------------ <br /> REVIEWED <br /> -----_------_.-.-_REV|Em/8J BY------------------------------------------------------------------------------------------------------------------------------ DATE--------------------------------------- .____._ <br /> 8U|LD|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ 0ATE-''--'''--''-''-'''-__.___ <br /> 4 ---- - ��'� '----' '-- --- ----------' <br /> ' `='-^^"`-.-=-",.,=`..=`=- `=.-^,"-.-Y�°- °- =^"_=.--�`"-���_.----__._--- <br /> /y� '----''--_-'''--''-_---''--'---'''--'�x��.''�� ''''--.''--K -''-'''-_-.'''-''--'-_--____ <br /> -'-'----'' ''' -'---'--'-- <br /> __--''' '-''---_-' <br /> RN/\L INSPECTION 8Y�' -.-.. Dota--..ki ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> -------_SANJOAQU|NLOCALHEALTHD|GTRICT <br /> /m s".m American Street 300 West Oak Street /32 Sycamore Street u/* North "C" Street <br /> Stockton, California Lodi, California Manteca, California Trmcy. California <br /> es-9-2w n°.u"o `'or p.p.00. <br /> _ _ <br />