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APPLICATION FOR SANITATION PERMIT Permit No .. ---_ <br /> (Complete in Duplicate) Date Issued <br /> Appllceipn i hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein cle r d. <br /> This app ication is made in compliance with County Ordinance No. 549. <br /> Installation will serve: Residence , Apartment House E] Commercial E] Trailer Court [I Motel E] Other El <br /> Wafer Supply: Public system El Community system 0 Private Depth to Wafer Table ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam [:1 Clay 0 Adobe Hardpan E] <br /> Previous Application,Made: Yes Ej No r_)0 New Construction: Yes N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if pu6lic sewer is availa6le within 200 feet.) <br /> Dispos I Fie Distance from nearest weK-4-6-0....Distance from foundati Distance to nearest lot lin?----57-------- <br /> ep <br /> Number oi lines Length of e � h line--' <br /> alAAeepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance'-to nearest lot line------------------ <br /> Cespoo|: Distance from nearest well-----------------Distance from foundation------------------ Lining material-----._--^._-- J <br /> �] Size: Diameter'-''''-'''-'''-'-Duot�'''---'''''-''''-- �d ^_ga <br /> . ^ ~- ^ .� - <br /> s. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------- .____ ^ <br /> [] ' � ~ Distance t6nearest lot line---------------------------------- ------__.—_-_---_----________.______ ' <br /> ' <br /> Remodeling mm�/ur repairing (describe) --_--- --------'------------�� ` <br /> ~ , <br /> ------'`--� �`����``�����������`����``����`�����'``````��� <br /> ---'+�+~~��x��a�-~~~-''^---------'-`~-~~''1�~'p^------------------'-------------------------' ' <br /> --._—_-__--._--_—.----..___.-..�_-._-_.____-.___--_._-._-_'-___-_-__-._--- / <br /> I hereby certify that1 have prepared Ais application and that the work will be done in accordance with San Joaquin County <br /> ordinan es. State laws,and rules and r ulations of the San Joaquin Local Health District. <br /> (Signed)........V\ 11 �Pu (Owner and/or Contractor) <br /> (Plot pjan, showing size.of lot....Ioc tion of system in relation to wells, 6uildings, etc., can 6e.placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> - <br /> APPLICATION ACCEPTED BY DATE � <br /> -REVIEWED BY U ^~ »T-- -'---'----''—'� ' <br /> 8U|LD|�N�� PERW|T |SSUE[\'-_'''----.''_ D�TE-''p'_-�-''-_''-__________ . <br /> AK*rmt�nsand/or ,ec�mmnndatons�------ _-----._----__-'_-_---_-___---.----_-__�__ <br /> --_'---.—''--'-'-'''--'''--.'_''- --'''--'''__.-_--''-_-'—_''----'''_-.-__''---___.`_____ <br /> ` <br /> --_'-'-''''''''''--.'-'''--'''-''_'''—''''-'''----'''''---'''-'-'-------'_-.'_-.-'-''--__-_'---_ <br /> '---'----''-_--'-'-'''--''-'''-''---''---''---'''-'''-_.-^_'-'''-_'--''''--'''-'_--'-''-'--'-_'' <br /> ________________________________ --------------------------- _---------------------------------------- -------------------------- _________________ <br /> - <br /> �� <br /> RN/\L INSPECTION BY�-----'''-/!���-�������_.-'- D*+o -'---�!.-'����'�-��^�''�--'-'--. <br /> ' <br /> SANJOAQU|NLOCAL HEALTH DISTRICT � <br /> /30 south America" Street 300 West Oak Street os Sycamore Street 814 North "C" Street <br /> Stockton, California L"di, California M*m**,. California ?mv» California ' <br />