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FOR OFFICE qSE: <br />APPLICATION Permit No. <br />FOR SANITATION PERMIT <br />A plica- Local Health District for a permit to cQnstruct and install the work herein described. <br />p tion is hereby made to the San Joaquin <br />This application is made in compliance with County Ordinance NO. 549 <br />Installation will serve: Residence, Apartm , ent House.L] Commercial [:] Trailer Court Motel C] Other 0 <br />Number of living units: Number of bedrooms -05-e <br />Wafer Supply: Public system E3 Community system E)'- -Private n Depth to a T b S A ft. <br />Chara�ter of soil +6 a depth of 3 feet: Sand E] Gravel 0� Sandy Loam El _.Clay Loam El Clay 0 'Adobeg Hardpan 0' <br />Previous Application Made. (If yes, date --- ---------------- No f] New Construction: Yes E) No Da- FHA/V <br />TYPE OF INSTALLATION AND SPECIFICATIONS*. <br />(No septic tank or cesspool 'permitted if public sower s available within 200 feet.) <br />Y,blpt c ank: Distance from nearest wO ----------------- Distbrice from foundation -------------------- Material ------------------------------------------------ <br />Seepage Pit: Distance to nearest well�zl� ----- Distance o)n f a ion --- /0 <br />Number of pifs'__ ---/ ----------- Lining material-- M- �Z­Size: Diamefer----33­3 ....... Depth ------ <br />` <br />Privy:! Didunco from nearest well --- _'''��''--'''-'''-''Distance from nearest b��Gng''-''-�'-'_-.-'-'' <br />[] -- Distance to nearest lot line ----------------- -------------------- <br />----..__..__.-'-_.._---.-__.__.__.-_____ <br />- <br />Remodelingand/or n:po�r;nq (describe): ------------------------------------------------------------------------------------------------------------------ --------------------------------------- <br />_.-'---_-.-_-__-..----_._--_.'-------------------------- :'-_--.- :------ --------- ------------------------------- ------------------------- <br />----------- __._,______.___�._.__._______-_-�--_.c=.�_.--_'�''--��'------------------�--- <br />---.`----_---'------------ _� -.------_-__-----___------------------- --------------------- '---------------------------- ------------------------------------ <br />I hereby certify that I 6VG 'prepared fhis'applicaj;'�d that the work will Ledone in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of e lan <br />uiin� I Health District. <br />on6/n,�nnt�*�or <br />p/gnwo�-. —^~~~------------'' -����� ' <br />____�__._�____'''-_-R��l-����8'�'''--'---­:`-'�-�(Plot plan. showi g size of lot, locafion o <br />— �-i- .4 sle. 'in elation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />~ DATE �i'�_ <br />/\PPL|CAT[ {}N ACCEPTED 8Y' .-�--_---_---.-.- -..��^��n=�- ------. <br />�� DATE- <br />REV|E\mED BY ----------------------------------.--------_------ <br />BU|LD|NG PERMIT ISSUED ------------------------------------------------------------ ---------------------------------------- DATE --------------------- <br />A�oru�onwand/or ,eunmmmn6mt�v� _ ____-__-�_________.. <br />- -- --------- ­ ------ ---- ------- t­i­,:�4--�� ------- ---------- <br />130 South American Street <br />Stockton, California <br />SAN JOAQU|NLOCAL HEALTH DISTRICT <br />300 WesiOcilk Street 124 Sycamore Street <br />Lodi, California <br />Manteca, Callfornla <br />2mWest a*Street <br />