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APPLICATION FOR SANITATIONPERMITPermit N� <br /> ~ ' `�o—mu�� � Cu'a�a�) <br /> . /P Date |,:ue6 '�_A!I�A <br /> a� <br /> � ~ ' ' ' <br /> Application is hany6y mo6n to the Sun Joaquin Local Health District for u permit to construct and install the work herein described. <br /> � <br /> This application is mo6o in compliance with County Ordinance No. 549. | <br /> " <br /> 0 Phone-- <br /> co <br /> �� Trailer Court � Motel � Other E] <br /> Installation ~J| serve: Residence 0 Apartment House [] Commercial v�. ro <br /> ^ <br /> Number of living units: '°=., Number of bedrooms '�== Num6o, of baths '�� �� " ��� Lot -��' �*--~"."~tn�m�°��-----._r---___ <br /> Water Supply: Public system El Community system [] Private x Depth to Water Table _7- f+. 1 <br /> Character of soil to a depth of 3 feet: Sand L] Gravel [:] Sandy Loam E] Clay Loam El Clay Adobe Hardpan [j <br /> Previous Application Made: Yes El No 9 New Construction: Yes Ej No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank; Distance from nearest well--$A------Distance from foundation----#49--------M-I teriaj--- ------------ <br />' <br /> Disposal ' '°'"' ~^'~^`~ ''`''' ''~-'-'' '-------- -Number of lines-----0MO--- Length of each line__-0_'A0° <br /> Width of h <br /> Seepage Pit: D�slance to nearest well----------------------Distance from foundation--------------------Distance to nea <br /> Remodeling and/or repairing idescribe):------A_0_11TZ_0� - 4 <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance: St ws, and rules and re 'ons of the San Joaquin Local Health District. <br /> (Signed)--- __AKS------- (Owner ancLo;or Contractor) <br /> C, system in r liation to wells, buildings, efc.. can be placedJon reverse side). <br /> K, e of <br /> (Plot plan, s owi g siz lot, location of <br /> FOR DEPARTMENT USE ONLY <br /> Altenntionsand/or recommendations;-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------_____�____^__'__��________________'__________________'____'___'___ <br /> '----'-�--'---------------'--------------'-----------------'---'---''-------- <br /> ''-----'---- ' <br /> v/ <br /> -^�~-_�— <br /> �-=_-' <br /> _.---_�N \L INSPECTION BY: <br /> t�_-- <br /> _ ^- � `- <br /> SANJOAQU|N <br /> LOCAL HEALTH DISTRICT <br /> /am South American Street amWest Oak Street mc Sycamore Street ow m"*h 'Cr g**° <br /> Stockton, California Lodi. Ca|»"mm Manteca, California Tracy. California <br /> ES-9-2w 8-51 Revised vv-2100 ' ` ' <br />