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" <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date issued <br /> Application <br />' is hereby made to !"e-Sm/ Joaquin Local Health Districtfor upermit toconstruct and install the work herein described.000cunvn a mode m compliance with County Ordinance No 549. <br /> JOB ADDRESS AND <br /> Owner's Name---------- <br /> 1 _.. '''-----''—'---'------ <br /> � d ' " ' - "�'---------------------. rnon*-__._____..___. <br /> - -.._-----.---'~=�.�'`-`~_-----'_----'------_.--_-------.- <br /> Con��c�o�� Name . x~�- --'---'—'--'---'— <br /> _ Phone- <br /> Installation will serve: Residence Apartment House 0 Commercial El Trailer Court [] Motel El Other F] ---------Number of living units: ___'_ mber of bedrooms Number of baths /_ Lot size -----------JjOtP <br /> Water Supply: Public system El Community system E] Private F(Depth to Water TabJe3o_ ft. ........... <br /> Character of soil to'a depth of 3 feet. SanclEl GravelE] SandyLoamE] C�ayl_oamE] ClayO Adobe L/Hardpan Ej I kl,�N <br /> Previous Application Madei Yes'E] No V New Construction: Yes El 'No F] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: __Z� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se ank: Distance from 'nearest well__,3,b__(--Distanc fr foun�a ion---- M t ial------CC <br /> Dis�ance from nearest well <br /> Number of lines ------Distance from foundaf Distance to nearest lot <br /> Sof <br /> Seepage Pit: Distance to nearest well----------------------D�stance from foundation-------------------Distance to nearest lot lin'� <br /> ID Distance to n6airest lot line <br /> I hereby certify that I have prepared this application and that----t"he----w-'o'*r-k----w-il-I----6-e' _d__o__n,e.in accordance with San Joaquin' County <br /> ordinances, State laws, and rules a.nd regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> OR DEPARTMENT USE ONLY <br /> BUILDING PERMIT ISSUED <br /> Alterations and/or recommendatio"ns: <br /> 11 <br /> 901 <br /> �4 ------------ ----------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT - r I <br /> li S."th American Sfreef 30D West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi. California Manteca, California Tracy, California <br /> ES—q-2M 8-51 Revised W-2100 <br /> ' <br /> " <br />