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I/ ' _~ � <br /> APPLICATION FOR SANITATION PERMIT Permit No. _��� <br /> (Complete in Duplicate) Dote Issued <br /> This Permit Expires I Year From Date Issued <br /> Application iohereby made +othe San <br /> -Joaquin Local Hom|fh District for apermit foconstruct and install the work herein described. <br /> This application i, made /n compliance with County Ordinance No. 549' ' <br /> � <br /> J{}D ADDRESS ____ .---._..___. <br /> Ownor, Nmm*._.- ------------- <br /> �_11411 --------- Phone_--------------------------------- <br /> Address <br /> Installation will serve: Residence Apartment House [] Commercial Trailer Court C] Motel [:] Other <br /> wate Supply:, Public Community system [] Private [] �D�� to Wafer Table /0 ft. <br /> � � Hardpan []Character of soil to m depth [ [ [ � ' <br /> � <br /> Previous Application Made: Yes E] No New Construction: Yes El 'N FHA/VA. Yes 7] NoD� <br /> TYPE [}F INSTALLATION AND SPEQFfIATIONS: / ' ` <br /> (No septic tank or caxspvr| pw,nn|tte6 if public sewer is available within 200 feet.) <br /> Distance from nearest well-----------------Distunc` � m foundation ------Material ---------------- <br />� No. of compartments Size--.----.--..'Liquid 6ep�6--------- Capacity/ � . <br /> |6 Dintonce � U Di }u � + dt� u�� to ^t /ct / ra <br /> *&, Nunn��, � '' �\ <br /> �'-- / /� /� De� ofGmo+� o � � - ot | n�+ . � -------------------------- <br /> Type of G|+vr mu _ ter Q <br /> Seepa <br />� Distamce to __ --'�' ' le---' _. to ^119, � _-'---'Num6er of p�s--/.---'Uning mutuhuL. C6ume+ec- � _- Dopf� = �^ <br /> esspool: <br /> Distance from nearest well-----------------Distance from foundation--------------------Lining material �-- --------------------------- <br /> F1 <br /> -'_--'__. Size: Diameter-- _---.-..�---Depth--------------------------.'n-------------------Liquid Capacity---_----_gals. <br /> Privy; Distance from nearest well----------------------------------- from nearest building--'--''-''-'-''�- <br /> �] Distanco to nearest Ynf line------_-.------.-'------------------------ --------'----------- --__--_--------- <br /> � <br /> Rvmo6eliand/or repairing (describe):--- \` <br />' ^ - - --------' �--'--'-- ------------------------------------------------ - `_.�''----''-----''-''-'-'_��'' <br /> -''-'---�''_-�_'----'''-_.''''--�'- <br /> that the work U 6o done in'acnnrd <br /> -_� <br /> with San Joaquin County <br /> ordinances, State laws, and3,,Iules �rid regm6fio-RI of the San Joaquin Loo-91 Health District. <br /> (Plot plan, showing size of lot, locaflon of syst.em in r aflon to w`�.ilis,, I���in f can be I placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> '~ ' ~~' ''—' ACCEPTED T-- -Y-----'W <br /> ' -� x4 ' <br /> DATE---- <br /> REVIEWED BY Jr'��� ----------' »«/�`DU|LD|NG' PERW|T ISSUED-_--_--- --'-''-_---------------------------------------- DATE------------ -------------------- ------------------- <br /> Alterationsand/or recommendations:----------------------------------------------- --------------------------------------------------------------------------------------------------------------- <br /> - <br /> �- -'''-''''_''-��'_-''--'----'--__''__-''_--_'�- '''-''_-_-_'_--__--_._--^' <br /> '---/^ --`----'--'----------'----'------------'-----'---'-^----'--' | <br /> .------------------------------------------------------------------------------------------------------ '''--'-''-''' ------------------------------------------------ _''-''' / <br /> ............... --------------------------------------- -------------------------------------------- '' ------------------------------------------- <br />/ RN/\L INSPECTION 8Y� -�� -----..�-.-.. Du�z--''-i1'- - -- '/-�~��- -''-'-''-_- - - - <br />| --���- ' 1 / ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street /32 Sycamore Street 814 North "C" Street <br /> y*""kt"". California Loji. California Manteca, California r="v California <br /> c,v-cw m°'`edu',vr,m. <br /> ��� <br />