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N-I. ` <br /> ^� APPLICATION FOR SANITATION PERMIT Permit No. .�� � ^ ' <br /> " (Complete in Duplicate) <br /> Dote Issued <br /> Application is hereby <br /> x <br /> made to the SanJoaquin Local Health District for o pnnnif *oconstruct and install the work herein described.. <br /> � <br /> T� upp|icution i, moJo /n compliance with County Ordinance No 549 , <br /> ' 6/0 <br /> -~~-------_- <br /> Address_.- °` -- -_-.---_-.---------_------.. <br /> Contractor's Name-----.���&AA- -.--.------./---------------------.-.---- Phone------.-----. <br /> |nsta|lation will serve: Residence rtmont House [] Commercial E] Trailer Court [:] Wo+o| [] Other 0 <br /> - � �� <br /> Number of living units: -/�.. Number of 6o6n,om, ��- Number of baths -^-�� Lot size ----- -----.--.- <br /> Water Supply: Public system grCommunitysystem [] Private F� Depth to Wafer Table <br /> , <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loom El Clay El Adobe 2---Hardpan E] ^ <br /> 'Previous Application Made: Yrs E] No [�3� Nmn Construction: Yes [] No n�~^6HA/VA. Yos [] N� El.. -- <br /> TYPE OPINSTALLATION AND SPBC|RCATONS: ^ <br /> (No septic tank or`cesopqn| permitted if public sewer isavailable within 200 feet.) <br /> Se <br /> Distance from nearest ,eU-----------------Distance from foundation--------------------MmfemiuL-._--__._.--__ <br /> Nu of compartments----------------------- -------------------- -----------Liqui6 dep+ --------------------------Capacity----------------------- <br /> D <br /> '-'--'-'' � <br /> Dis' | uDistance from nearest ve| ------Distance from ounduUon..14--- <br /> '------Distance to nearest ]of |i --��.°-' <br /> E?' Number of |�n*s------ g+6 of each |in"----_36.v Width of french <br /> Seeit Distance to nearest weU.������-' ' n-�ot� <br /> .- on-- ---Di�onc^eto nearest lot line-------------- <br /> Pell, <br /> . ~� <br /> ^ Numbo, ofpifs--J-,- ..Lin�ng Diomo+nc- - .--DuFd6----IR�.r--- - i <br /> +J <br /> Cesspool Distance from nearest °eU---_--Distancofrom [oun6*�ion------Lining maferioL--'-''�—'--''-- '] <br /> [] Size: Diomo+ec _'��'—�- �'��-''Dom+ --'''''''''--'''''--_Liould Capacity----------------------------gals. <br /> Privy: Dldunos from neun,s+ weU--- --------------------- --------------------Distance from nearest building---_--._---_ Y? <br /> Distunoa +onoana,+ |of line-------------------------------------------------------------------------- __.''_-'''-'--''-''-'''-'�_�_� <br /> ' Romw6aling and/or ropuir;ng (ciescribm):------------------------------------- ---------------------------------------------------------- _-------------------------------- ----------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------'--__.'--_'---''---''''-'''--'-'--- <br /> ' <br /> _-''--_'---''_-�---__'--__''-_'-__-'--__'------_--__'-''___''--_-`'_-.''---'-_--''''-'-_-'-- <br /> ---__-._-_.--._______--_._-__--__---_-__-_-.-__.-._-_-_'_-._---_-----' y` <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in rela n to Wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> _____ _ PERMIT ISSUED __' _AT_ ' <br /> commendations:-------- A/ <br /> � <br /> � . <br /> � <br /> r —'--'- ---------- <br /> -------------------------------------- ------------------------------------- � <br /> '� <br /> FINAL INSPECTION BY: ��p�� ' Du+v'_/—���'o '''=`' /'.-'''---_'-______ <br /> SAN JO4AQU|N LOCAL HALTH DISTRICT ' <br /> 130 South American Street 300 West Oak Street /32 Sycamore Street 814 North "C" Street <br /> Stoaton, California Lodi, California w«"te"°. California Tracy, California <br /> | <br />