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. � <br /> ' ~' ' <br /> _- ^�� <br /> --- �/ � ' � APPLICATION FOR SANITATION PERMIT Permit No. <br /> " <br /> ' (Complete in Duplicate)" Date Issued <br /> , Issued � <br /> Application is hereby made to the San Joaquin Local Health District for u permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ` <br /> Installation will serve: Residence 04--"Apartment House [-] Commercial Ej Trailer Court [] Motel [3 Other [I <br /> Water Supply: Public system El Community system F1 Private R Depth to Water Table -------- ft. <br /> Character of soil toadepth of 3 feet: Sand E] Grave| E] Sandy Loam 0 Clay Loam E] Clay [3 Adobe[:] Hardpan F] <br /> 9rmriomm Application k4mdm: (if yeo'6o^n--------------- ---- No El New Construction: Yes [] No [] FHA/VA. Yes [] No [] � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or ce*qppp| 'ennHtmd if public sewer is mra\|abkw within 200 feet.) <br /> 3pDistance from nearest well-----------------Pistance from foundation-------------------Mmtn,ioL--.------.-------- <br /> � <br /> No. ofcompurtm' onts--------------------------size..''..._----_---Liquid 6apfh------------------------Capacity....................... <br /> i / <br /> Disposal Field: Distance from Distance from �m���o <br /> Number of lines---------_... / -. --Leng+ of each line-.-��]�_._--vv�+x of trench <br /> � <br /> Type of filter ma!odo| - ----Depth of fi|ta, material .-/_&°'_-]otu| - .......................... <br /> Seepage R+: Distance to nearest weL-._---_'Distunce from foundation....................Distance to nearest lot km^._--__ <br /> [] Number of bits---''''-'''-Lining material----------------------- Diameter........--------------Depth--------------------'------ ^n <br /> : Distance from 'n"no,n, well .__.-_Distance from foundation--------------------Lining muteriuL-__--._—_ <br /> [] Size: Diameter_------------------------------------Depth---------------------------------------------------Liquid .... ------------------gals. <br /> Privy: Distance from nearest well _'-'-'''-'-''-'''--Distance from nearest building-------- <br /> Distance to nearest lot line----------------------------- ----------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing :- ------------------ -------------------------------------—.J�----------------------------------------------------------------------------------- ' <br /> '—'----------''----'��'---'----'--------------'---------'--'-----'----'-'----'' <br /> ._---_.__..__._-----''-----.---_-__.-____-__.--___'-_--'-_-''---_'-'---_-_-___-_--_—.__-- <br /> -----'------'----'--^---'-------'---------'------'--'--------'--'----'--'-----''--'-- <br /> have pre' and that the ww� wN6e �n w��6 with San County <br /> nd rules an ns <br /> `~g.~~/_ - -_.r_-' . <br /> ordinances, State laws, and rules a d gu ti ons of the San Joaquin Local Health District. <br /> ~ _--''--_''_'-_---__'----'`.--,'_-.'--''--.'-'----'''-'-' <br /> (Plot plan, ���g � of lot, ' � �+ m in relation to wells, 6uildingo, etc, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> pw/LD.mG rER"x// ISSUED--------------------------------------------------------------------------------------------------- °AT�._-_-__.____________ <br /> AMen,timnwan6/nrrecommendations:-------------------------------------------------------------------------------------...... ......... ..................................................... . <br /> .--_-_-._---------_-.---.------_--_--..__--_---_._-_--'-_---_-_-_-___.-_-' <br /> ���-1.__:----------�_--­---_---_---___--- -------------------------------------------------------------------------' --------------------------------------------------------------------------------------- <br /> --------------------------------------------- --'---''----'--------'----'-----'----------------------' <br /> '--'''-'—'--'----- ' '-''---'- ' --''-'-'''--''--''--''-'''-''''-''-'--''---'— <br /> �� <br /> '�N/\[ INSPECTION 8Y�--���-'' / Duto-, ,r�_.��_--.��--.��----_-. <br /> °.°/ <br /> JO��U|N LOCAL HEALTH DISTRICT <br /> . ��� - . <br /> 130 South American Street M West Oak Street 124 Sycamore Street 205 West 9th Street . <br /> Stockton,California L"l,California Manteca,California Tracy,California .� <br /> ' <br /> "f�° ""VI"= =.°" 2" °'°. AI°° <br />^ <br />