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. , <br /> FOR OFFI <br /> -------------------- <br /> -- � APPLICATION FOR §ANITATUON PERMIT Permit No. | <br /> (Complete- - Duplicate)-' ' Dofm Issued <br /> ye'r <br /> Application is hereby made to the Sam Joaquin Local Health District for a permit to construct and install the work herein descrImed. <br /> This application is made in compliance with County Ordinance No. S49.' <br /> Installation--will serve: Residence 0�'Aparfment House [) Commercial [] Trailer Court [3 Motel [] Other [3 <br /> Number mliving units: '1- Number ofbedrooms ---3Number of baths '-I--' Lot size ___^_ <br /> Water Supply;- Public system [] Community system El Private 1--6epth to Water Table 4Tft � <br /> Character ofsoil towdepth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam C] ClayAdobe ff-Hmrdpan0 <br /> Previous Application Made: (|fyeo'doto--------------------) No0�~-New Construction: Yes [B-No [] pHA/VA. Yes [] NuD3~-- <br /> TYPEOPINSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank or cesspool permitted if mubGm?ewer is available within 200 feet.) � <br /> Set' T nk- Distance from || '�� from f 6 ./a 1V No. of compartments-------Z---------------Size.......jK.47.'X.9 Liquid cle fh------9----------------C�apacity..... <br /> ^~� <br /> Disposal Field: Distance from nearest woU �/�, .�D--Diutunoe from foundationx -_-Dl�unoe to nearest lot |ina...���.-�.'. | <br /> rm�~ Number of lines------- <br /> Length of each line--,��� <br /> . ~ __Width oftrench-'����*�.__-- <br /> Type of G|hmr matm�uL�.. --.Depth of fi|to, ,nu+o,iaL-/��,---Jotu| length------ .................. <br /> � - four Pit Diotmnco +nnoamv ' . n�unm�t �+ l�o <br /> � m - ~ -� <br /> NunbarcfpMs._. —Uni (.- CADept h �.�—~.. <br /> ` ..c.�- <br /> Cesspool: <br /> ' <br /> Distance from -nearestwoK-_---Distunce from foundation--_---_Lining material ---_--_--_ <br /> Cl Size: Diameter'''-'-''---''''-_.Depth----------------------------------------------------Liquid --'-- <br /> P,ivy: Distance from nearest well -._-_.—__------Distance from nearest building-_-'_.----___.`-� <br /> [] Distance tonearest lot line---------------------------------------------------------------------------------------_-'-----___.--_- <br /> Romu6oing and/or repairing (describe):--------------------------------- -------------------------------------------------------------------- -------------------......................... <br /> ...........................................-------- ...------------------------------------ --------------------------------------------------------------------------------------------------�!--------- u <br /> '--------------------'--------''`---'-----'--------'---'-'-----''------'--''--'--' Y <br /> | hereby certify that I have prepared this application and that the work be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulaifions of th A&naqu/inL.o al Health Disfric.f. <br /> (Plot plan, showing size of lot location w* � <br /> FOR DEPARTMENT USE ONLY � <br /> ' <br /> Alterations ^ <br /> ~ ~. ----�'-- ---'''--.-_-'~-----''---------'------^--_'- ` <br /> . <br /> ' --'-'''----''--'--'''----'--''--------''------''-- ' <br /> — -���' '-''-- -'-_.'�-_.'-_.,------'__`-_-_-.--'-`_-_--^----- <br /> -- . . ` <br /> '—^^^--'�-7-�----------------'-=-'`--'''^---------'------''---'-----'------' ^ <br /> —'--'-'--��..---'--------- ------------------------------------'''-'----'--'-''''_'--'---''-'--' <br /> HNAL INSPECTION BY%-'' Date---------- '' -----r-----''-''_-'-''-' <br /> - " <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT . <br /> ` <br /> . <br /> 130 South American Street 300 West Oak Street v2* �� �� �oW��o� <br /> ' <br /> ~ <br /> Stockton,California Lodi,California Manteca,California Tracy,California ` <br /> "° p ""VI"" """ *" °~u ="= <br />