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APPLICATION FOR SANITATION PEPMIT Permit No. <br /> Or <br /> (Complete in Duplicate) Date Issued <br /> Application is hereby mode to the Son Joaquin Local Health District for a permit to construct and install the word herein described. <br /> This ap�'icntinn is made ;r complinnc-, with Cou,-t-, Ordinance No. 549. <br /> JOB ADDRESS AN'LOCATION....-. <br /> .. <br /> Phone. .. .. <br /> .... ----------------- <br /> Ow6cr't . ..... .�__ ..... .. .. <br /> Address---- ——------- <br /> ....................................... <br /> C;jr.tractor's NI'me.. . Phones..... <br /> Installation will serve: Residenc% r] Apartment House [I Commercial [_j Trmiler Court 0 Motel <br /> _4 ...77_.. .......... <br /> Number of living unit::I.C. Number rf hearooms 2, Number of baths -2- Lot site --5.4- <br /> .. .. <br /> Water Supply: Public system. L-1 Community system Ej Private 1��Depth tc Water Tabled 0.'ft. <br /> C.hrracter of soil to a depth of 3 foci: SendEj Caravel L] Sandy L_­ain El Clay Loam[I Clay E] AdoL,e E] Hardpan <br /> New Construction: Yes D No Lyl— <br /> Prey:ous Application Made: Yes [j Inc <br /> TYPE OF INSTALLATION AND SPcCIFICATIONS: <br /> (No septic: tank or cesspnot permitted if public sewer is available w;ihin 200 feet.) <br /> Material.._.__.... ............ ---.•- <br /> • <br /> --------------- <br /> Disfance from foutidat;cn................... <br /> S tic Tank: Distanc6 from nearest weil. <br /> tI'0 of compartmants. Size.......... ........Liquid clrpf;�.. ...... .. ..... copacity.......-------...... <br /> e t <br /> 47- D;s' D;sfarre 'rc-n foundation.51� ......Distance to nearest lo <br /> line <br /> n;spo.a' fance from nearest I ength 01 each Ene/30.-L-.2.-c.,'- _Wic.'h of tren. ......*��............... <br /> Number of lines........ :. <br /> ,'i /-� Z, <br /> Type of filter ,/�r/j,.Dcpih o" ';Iter malerial... _Total length... .................... <br /> ii -Distance from fqundotion__/�/ a_' -Distance '-o n,,-arest lot <br /> Seepage Pit: Distance to nearest we <br /> pits. �? .Size: IVT: <br /> Diameter Depth...9J. .................... <br /> bc:r or - material._ <br /> -Distance from foundation Lining material--- ------- ----------------- <br /> Dts*.ar.ce from nearest well...... <br /> Size: Diameter. Depth._.......------- ........ .. ......... ----Liquid Capacity--------------------------gal';- <br /> nearest bu';d;ng------------------------------------- <br /> Privy: <br /> Distance from )Cares' w,61 . ..... •Dis.ance from ......­.......................... <br /> ..... .. ............. .... ........................... <br /> Disf,3nce to nearest lot I'ne <br /> Remodeling and/or rep;!ir'09 (describe): ------- ------- ----------- .. ........................................... <br /> ............................._­............................................. ......... ...... .....................................I................................................... <br /> .......................................................­...........­..... .. ... ..........................._ ..................................... <br /> .............. .. ...... ......... . .......... I............ ................. <br /> ............. .............. ........... .................... <br /> I hereby certify f1laf I havo preparad this application and (hat the work will be clone in accordance with an Joaquin County <br /> ordinances ktat, laws, and roves an regulation; of the San Joaquin Local District. <br /> _11—f-ontractor) <br /> (S(Signed). ...... .(Tifle) <br /> buildings, etc., can be p:aced on reverse side). <br /> (Plot plan. showing -size of lot, location system in relation to wel!s, <br /> ENT USE ONLY <br /> FOR_6E­�AlkfM <br /> DATE_ r <br /> ... .... ... \;% <br /> ........... <br /> APPLICATION ACCEPTED BY ­ DATE -- ------- --------------........... <br /> REVIEWED B'( - - DATE.. . ................... <br /> %T !SSUED........ . <br /> BUILDING PER recommendations: <br /> ..... ... .... ............................................... <br /> Alterations and/or . .. . ....... .. .. ................................................ <br /> _7 . .. ... .............. .... .............. <br /> ............. <br /> -- C /� j,i�; �' C . Date ...... <br /> Flr.1AL INSPcC7!01 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT via NO-A "C" 51'..1 <br /> 13i Sycamore Slre.f <br /> 300 <br /> S.� An.,;c&- M.,f&ca. CaliforniaT,,icy. Cei;folnSouth <br />