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� . <br /> APPLICATION FOR SANITATION PERMIT Permit <br /> � &p �unkcat� <br /> (Complete '—, Date Issued <br /> Application is hereby mode to the San Joaquin Local Health District for o permit foconstruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br />| <br />� � <br />" <br /> Number o[ |hving units: -L.. Number of 6A%oms,.^~--- Numbe, of baths _ Lot sizu -__--_-__- ' <br />' ' <br /> W� Supply: Public system �. [�m�� system � P�� F1 Depth � Wafer Table _' � � <br /> � <br /> Characterof _' to ' depth of ^~ E ' Loam -- Clay Loam -, . -- Adobe -- Hardpan _- <br /> i rmnmus ^~pp"=",=° ""ad= '"" Ll No JX ',ew Cp �s '"^"= 'es D4 No 0TYP ' <br /> � - <br /> OF INSTALLATION AND SPECIFICATIONS. <br /> (No omfic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> � <br /> Septic Tank: Distance from ||'�"__0_eDisto from foundation -//0- <br /> Material <br /> ) ^ wu+� | -/ ���N + compartments---- S' �2 � dm - C <br /> Disposal Field: �on:� W |*��ff.Di <br /> f <br /> n <br /> oc | <br /> �Numbnr of lines------------ '- Length of eo of trench <br /> Tvpe - , <br /> of �|+�, m�+erloL.-2[����--..D�pf� of GHor mn+�r�uL-����.--..Jo+a| |ength-_--2���%�-.����-- <br /> Seepage Pit: Distance to nearest well .---'--Distance from foundation--------------------Distance +n nearest lot line----------------- <br /> El <br /> '__-- <br /> El Number of pitc'--_--'-_Uning material----------------------- Diameter_'''''''��-Dept h--------------------------------- <br /> � <br /> Distance from neoras �e|_--'--D�t ncefn»mfuundut�o'-''''--Un�g moto�aL-'--_''_-_-.��_ n - <br /> 0 5br: Diameter--'_._-------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: -_Distance from nearest well -'--''�----_-'�.'-----------D�stanco from nearest building----------------------------------------- <br /> E E I tidanceh, nearest |of line--------------------------- ---------------'�-_---__.____._______.____.____ <br /> � . � <br /> Remodelingum6/qr repairing k]uocri6,� --------------------------------------------------.---------------------------------------- ------------------------------------------------------------- <br /> | '—'----'--_--''--'---------------------''--------'--------'-----'--'------------''--'-'---- <br /> | '---'--'�--''--''-��--------'----'---------------'-�--'--''--''�-----------------'---' <br /> . '-''-'__'_-.�_�''__--''-__''__.__.'--_-'-'--__-'_^�--^__.___'''-_'--'--_.____'-'-''-''--'--' <br /> Y� hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> | ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> � <br /> (Signed)--- -----------------------------------------------------------------------------------------------------(Owner and/or Confractnrl <br /> . -----.----,-_--_.-----------------.----.----------- ` le)---------------------------------------------------------------- <br /> � <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, nfc, can be placed on reverse side). <br /> y ` <br /> FOR DEPARTMENT USE ONLY <br /> ---e-2- ----Ze <br /> Y� -__-__- <br /> -- /'_��''' �����,������������������ �� . / . <br /> � ---------------- <br /> ----------------------------------- .... <br /> -'' -_''''-_' --'''-_'---'----- <br /> \�� T\ ]- <br /> FINAL INSPECTION BY--------------------------------------- ------- Date'�� -' 'L '''��''''----_'-'''-''' <br /> . <br /> SAN JOAQU(N LOCAL HEALTH DISTRICT ` <br /> /ao s"om American s*"m 300 West Oak svmot |vz Sy=°m",* str°°v 8/4 North ^o" st=m+ <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 1 <br /> ES-9-2M M/ m°.iso6 vv-2100 <br />