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APPLICATION FOR SANITATION PERMIT Permit N �� <br /> - %���n�� � C�o�a�\ <br /> ` '-- '-��^ Dote |�xu�6 °- <br /> � <br /> ,\ Application is hereby made to the Son Joaquin Local Health District for o permit to construct and install fha wo,.k herein described. <br /> his application is made in compliance with County,&din e <br /> r / <br /> � <br /> Owner's Name- <br /> Address----I---0-11 a_1------------------ --- - - - - --------------------------------------------------------------------------------------------------------------------------------- <br /> Installation will serve: Residence Apartment House [] Commercial El Trailer Court E] qotel E] Other E] <br /> Number of living units: ---T umber of bedrooms 2__ Number of baths ---L. Lot size T__---I------------I------------- <br /> Water Supply: Public system ��mmunity system E] Private E] Depth to Water Table ------ ft. <br /> Character of soil to a depth of 3 fee+: Sand P Gravel [] Sandy Loam P . Clay Loam ;Kclay E] Adobe E] Hardpan Ej <br /> Previous Application Made: Yes D N 0 R� New Construction: Yes Yr No F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> . <br /> (No septic tank or cesspool permitted if public sewer is availablehfee <br /> Septi ank: Distance from nearest well -- Dist + <br /> No. of compo _ Sbc-a� �_C�- -- Li <br /> � <br /> Disposal Field: Distance from nearest well Distance from foundation <br /> �Jr ----------- <br /> Numberof lines of each line--------- Width oJtnenh _- <br /> ' -- <br /> Type uf �|+or m�+e,i°pop+h of fi|+or material --/.9--------Total length-----/k&---------° <br /> See R Distance to nearest well---. Distance from fou 6oH Distance to nearest lot line__ <br /> ' El' Size: D�meto,'----.--'_-.-��_-Deofk ''�__-'''-_--''''--_-L�u Lining Capacity------------------ ---------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building'-'''_--___-__-_ <br /> ElDistance to nearest lot |�e--'--�'�---'''-''''—'_-_-'__.--_'---___.---__-'_-__'-_---^ <br /> Remodeling and/or repairing (describe):-_----_----------___.-------_.--_-__-___._-.__'___-.____--____-__- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------- ------ <br /> �W <br /> � ------------------------------ <br /> . ~ -__..---'—.�__-_--.'--_--__- ------ ----------- � <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> � '---6^���'` that '- prepared <br /> ey <br /> ordinances, <br /> laws, an�;dules nd - gul0flons of the,$ n Joaquin Local Health District. <br /> , <br /> ' . <br /> ' ~'^---'--'-----' lb '''--'---''''''---t*'''~/''----��---'''----''----'-- <br /> (P|n+ p|an. size of lot, location of wo|6. 6uil6ingo, ofm, can be placed on reverse side). <br /> ' FOR DEPARTMENT USE ONLY � <br /> -----k :---------------------------------------------- ------ - ------ -------- <br /> Alterations and/or recommendations:----- <br /> ---'---------'--------'-----'-----------------'--------'---'-----'-------------'--'-'' <br /> -_._-_-----_--------.------�---�__-.-_-.-'__-----._---------_------_--._�---__- <br /> '-''-_.-''---''''--''''' '--''''---��'--��� '-''-''--'-- <br /> FINAL INSPECTION BY ---------------------- D � ' -��-''''----------''-''- <br /> �r~ � <br /> SAN JOAQU1N LOCAL HEALTH D|STRk�T -~ <br /> ou South American Street 300 West Oak Street ' /zz Sycamore Street ow North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ` FS-9-2w o's/ n°./""d vvu/nu <br />