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V '^ <br /> � -' <br /> APPLICATION FOR SANITATION PERMIT _ PnnnK No. <br /> \ 0 -m <br /> (Complete in - v <br /> -r--'-/ Dofn |muo6 <br /> [ <br /> . Application <br /> This appilicafion.-is made in complianc w'.h ounfy 0 d nance o. 549. b'7'7— -S-70 3/ <br /> � _d -s-------------�^����� ���_ <br /> Installation will serve: 'Residence PT"—Apartmenf House E] Commercial E] Trailer Court E] Mofel.,D. Other 0 <br /> Number of living units: Number of bedrooms J__ Number 6f baths /_j__ Lot size ---------------------------- <br /> � '`~'~' ~~rrr Public ^r'~^ Community- system El Private n `-rr- to Waferfable— ''^~ ''' <br /> . �-~�� <br /> ��c�� �W � m �� � � �� �� � ��� � Sandy C� i�m � Clay El ��� no�� � <br /> � ' ' i . ' ' <br /> Previous Application Made: � No ��N� C����� � ��o F] �A�.'�» [I^ \ <br /> TYPE �f INSTALLATION AND SPECIFICATIONS: <br /> . . � ~ <br /> (No septic tank iftedif pu6licsewer is available within 200 / <br /> Sc k: Distance from nearest well-A7Distafoundation M te 91i A!__6 <br /> Disposal D|sfonce from from ~, <br /> Number "of lines' - --- Length o; <br /> � h | o/fif <br /> 7,pp of filter mo�x�| ot of G|+or mofe��./T'. | <br /> �;vpmgo <br /> ��� Distance to neunv� .o|L------D�+ ~~ �fn,m foundation /to naonu+ |o+ |�e-���--- <br /> / 1:1 � Number of pifs -----.-Uning material----------------------- Diameter.__-_i-Depth ----__---. a9 <br /> ^ � <br /> Cosspno|: ? <br /> Distance from nearest well------------------Distance from foundation--------------------Lining ma+ohoL---------.--.- ~` <br /> [� Size: Diameter---------------------------------------Depth-'''-'�'-_-''-'''-'''-''Liquid Cupaci��-'__''--'-'oa�,. <br /> ` <br /> Privy: Distance from nounox+.woU-------------------------------------------------D�stonce from nearest building -'_-'-''-'- <br /> �� <br /> - �Distance to nearest {of line --_--- �--_----' <br /> --------- <br /> Remodeling <br /> and/or-'repairing (6e, r;be)�'--- <br /> ------�--'----'''--'- -� ---''- -''_-.'_- __ -l. <br /> ------------------------------------------------ <br /> ------------ <br /> '-_,'_---''-_''_-'-_. <br /> ----- - '---''---'-'---''--''---'-''----'- <br /> J� <br /> ----__-____'__-''-`''__.-_--__.--___-_-_-.--_---_-_-_'..--''--_-__._'--._--- <br /> [| ----_---_�.-_-_-.__--''--''--�'--- --''--'----- .-_.-_''-_--l_.'''_-.--''-'-'-'-- <br /> h� � | have prepared this � �� � w� � be '� in �� with � Joaquin County State laws, J � ofthe SanHealth <br /> � <br /> � Lp�o| H K� ��+�ct <br /> (Signed� e��. - *�r�� \� <br /> ' . <br /> � <br /> By: <br /> 'Plot plan, lowing size of lot, location o iternin relation to wells, building,, e1c., can be placed on reverse side). <br /> \ FOR DEPARTMENT USE ONLY <br /> � /\PPUC*T|ON.ACCEpTED 8Y.-' um------------------------- ---___-------------------------------- DATE--r7�_/ <br /> ) ---------------------------------- <br /> REVIEWED <br /> -----_.---_---KEV|EWED BY----------------------------------------- ---------------------------------------------------------------'�-�'�-',' DATE_.�''-'''-''-'''_-'-'---'' <br /> " BU|LD|NG PERMIT ISSUED.--.-----.-_----------�-_---_----.___- DAT�--------.�---------_---. <br /> � /k|h,,aGonoon6/n, ,��om��ndallonu�------------------.-_-.----__----.--_--_-___-----_--_.---- <br /> ' ' <br /> � '-_'--'--''_-.'--'''--'----''---''`~'---'''--'-''''-�_.'-_--_'-_.-'-'''---'--_.-''---_.--_-''-'- <br /> � '_-'_---�-�''_-'_--'-'---'-''''-'''-''_-. '-''-��' -' --------''--''--'_-''-'''-'_--''---'_-_.---'- <br /> � -_._-_---_--__-_---__--_-_-------.--_--_-------_-----_----''_'---'-' <br /> '--------`'-'--'-'''-''--_-''-_.--'-'''--''-�'--''-''--'-_'---''--''''-''''-' -------------------------------------- <br /> FINAL <br /> '.-''-------'-- <br /> . _ .�' <br /> _- � �l_~ <br /> « �N/\L INSPECTION BY�--.��.����`��---__'�-_- Du+o---.-�---.� -� -���-.��---_--. <br /> � <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT - <br /> 130 South America" Street 300 West mak Street /32 Sycamore Street 814 North 'C" Street <br /> Sto"kto", California L"d/, California M""*""a. California n="v, California <br /> m ' ss-'p-�w ' R°.�,°� �'or p�pzo. <br /> �^� / <br />