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` � <br /> _' _ . . <br /> ��t <br /> -----� �~'—'-`- <br /> � ~' <br /> APPLICATION FOR SANITATION PERMIT . 0ermit No. <br /> ~ ~ Duplicate) <br /> ^ (Complete �m —Expires I Year From Date Issued Owfa Issued <br /> Application is hereby made to the San^ <br /> Joaquin Local Health Dist rict1o, o permit to construct and install the work herein described. <br /> This application is made incomp|iffnca with County Ordinance No. 549. <br /> Installation will serve: e_� <br /> Residence (P Apartment House [3 Commercial Trailer Court [] Motel [] Other <br /> Water Supply: Public system M--tommunity system-[] Private [] Depth'to Water Table 6;�! ff.-- <br /> Chmno*tmrwfmoil to a dwnfb of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam [] Clay Admbw2~01-lmr6mmn [7 <br /> Previous Application Made: (|fyes,date-------------- --- /No [] New Construction: Yes [] No8~~"'FHA/VA. Yes [:] No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> septic hwnh or cesspool permitted if public sewer is available within 200 feet.) / %tic ank- <br /> / <br /> Distance f ` nearest well----------------- <br /> Distanco from foundation............. ----WmteraL-'-�--.---.__.—'--- <br /> No. of �ompartnents------------------------'.Sizn------------------------'^'Liquid 6wpth--'-'---''CmpucHy.--_'-''-�- <br /> ' <br /> Distance from nearest well-----------------Distuoca from foundation....................Distance to ne'arest lot line------...... <br /> Number of lines------------ '-Length of each line' - ' Wi6th of trench----------------------------------- <br /> Type <br /> ' '------ <br /> Tvoo <br /> � <br /> ofGH*rm��o,�L'_-''---'�Deo+ of ��er mofo6ui'-_.'----Totm �nuth-�--___---__-.--- <br /> v v . <br /> � <br /> Distance +n nemnmst |n+ | <br /> ��- <br /> Number ofpits------ --.���e� D�mefe,'����.~-_-De�th--��-�'" ._--- <br /> Cesspool: Distance from nearest well----------------- from foundation------------------ Lining material..................................... <br /> 36e: Diameter------------------------------------Denfh----------------------------------------------------Liquid Capacity---------------------------- <br /> Privy: Distance from no*,oa well'_'---'''_-'''--''''Distance from nearest building------------------------------------------ <br /> El Distance +onearest lot line----_-.---------____..-- -------------- --.___.---_-_.-`--' � <br /> RemuJeing and/or repairing (demzibo):-_-_-_--__-_-----_----.--_-----__-___--_'''^------.'-�-�--- <br /> -- - - � _-_- <br /> --------'----'----'------'---------'----'''''''-----'-'-----------'--'--------------'---------- <br /> ---------------------------------------------------'----------------------------------------------------------------------------------------------------------------------- ----------'----------------------------------- <br /> ----------------- ......... ------------- -----------------------------------..........---------------------------------------------------------- -'--'---'' .......... ........................ <br /> I hereby c I that I have pre' <br /> Oared t * application and that the work will 6e cl�nle in accordance with San Joaquin County <br /> e gue '�+ <br /> ordinances, St e ws, and 6Ae- nd regul t* ns of the San Joaquin Loca(Health District. <br /> (Siohed)--------0......­-­...........V.". ----------—- --------- -- - - ------------- -- ----------------------- --(Owner and/or Contractor) <br /> By:--------------..........------------------------------------------ A - - ---- --- -------- --------------------------(Tiptle)-----V----I-------------------------------------------- <br /> (Plot plan. showing size. of lo+, location of system in relation to wells bildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -------------- <br /> _ ~=`, <br /> �/'�`\ -- -----------'-------------- <br /> /rINTION <br /> SAN NLOCAL HEALTH D|STR�T <br /> / .°° ""�°° xvovv°mOak»�*° 1o4sv�mw�m�° , 2puWest�x��e, <br /> "/" Lodi,California Manteca,California Tracy,California <br /> "o 9 =""m "'". °" °'". ^,L^" <br />