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FOR OFFICE USE: y- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ............. <br /> (Complete in Duplicate). , - 11 <br /> sf <br /> Applica.tion 'is hereby 6de to the San Joaquin Local Healih District for a permit to constr I r all the work herein described, <br /> This application is made in compliance with County Ordinance No. 549. i54:f, <br /> Contra <br /> Installation will serve: Residence CE Apartment House 0 Commercial Ej Trailer Court E] Motel [] Other E] <br /> Water Supply: Public,system E].- Community system 0 Private [-] Depth,to Water Table 4A ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [3.1'Clay Loam@ ClayE] AdobeE] Hardpano <br /> New Construction: Yes No FHA/VA: Yes F No <br /> Previous Application Made: (if yes,dote-----------;--- ---- No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 10 � 4 k <br /> k or cesspool permitted if public sewer is available within-200 feet. <br /> Disposal Field: D;�tance from nearest well -,,5------------Distance from foundation -------------Distance to nearest lot li'ne <br /> Seepage Pit: Distance to nearest well-I----r___J-----�__Disfance from foundationw ------Distance to nearest lot line----------- <br /> Privy: ...Distance from nearest well_ __ 404 � V <br /> . �� . <br /> Romo6oUng nn6/or n�pnirin� k]a '-''-'-'__'----_-.--'-- . <br /> --_-___.--__.-_—._-�--. ���.---..`-_---�._--_._'-`--__-'_--_--.---_----._--'--- <br /> _________'_____________�__'��______________________ ____'____'______________'______�_____ <br /> ---''__�-'--''''_--�,--_--.''�__--''-�-'-__'---''--''-'�-',--''-'---'-'~'--�-- <br /> I hereby certify that�------'---~-� | have prepared this application and that the work will be done in mmcon]onua with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> / \nvr plan, ^"""'n�"z= of '~'.~'^~`^~' ~'-r—'' in rel--'ion— to wells, 6uildings,'.ett., can be placed <br /> p <br /> - <br /> R DEPARTMENTUSE ONLY:- <br /> CEPE� � * <br /> -.—.___-_^-__-- DATE <br /> -�-..� ------�- <br /> --_---___\PPLKAT|ON AC <br /> KEY|EVBJ 8Y''''-�'''-''-'`-''-''_��--''---_'�----''-''''-'-`---'' DATE-'-''''--'---'---'------ <br /> - BU|L0NG PERMIT ISSUED_----------------------------------------------------:------------------------------------------------- D,ATE---------------------I--.-----__.___- <br /> ____.__._________.______- <br /> A�w,�6ono��d/~- n� �___________ _ __ _`_.__.___ <br /> r � ------'-'- <br /> '-'-'-',''''''________. ._ _ ,________------_-_ '''--'---'-'-'''-'''----'''---' <br /> ' <br /> --'�--'''-'''''-----�---'-'''-''-- �'--'--''--''''-_'''---''-'''�--'--'''---'---.-'--''_-_--'-'_ <br /> —''�'---'''-'—'-�'''''�-'`''�-''----''''^'''_-''''-''---''^---'—'''--''''--'''---'—_-''-'��. <br /> -''— �----'''-�''----'_--'-'''--_'''-''''-'�---'--'�--'--_'''-'�--_''-''_'- <br /> ----------------------------- <br /> - ' <br /> RNAL INSPECTION 8Y: '''-''-- Date-- ----------------- --- <br /> JOAQU|N LOCAL HEALTH <br /> ' DISTRICT <br /> � <br /> 1601 �w°"w�"Ave. . ~, xvmw°*Oak s�=, o*ov����»^~° xv,�"�n^e�° <br /> Stockton,California Lo.di. Cal/fornia Manteca,California Tracy,California <br /> "° ° °=°S"° ='"° 3° =~6" "~"". � <br />