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."APPLICATION <br /> ~+ <br /> `~^ -APp� ����� <br /> �� FOR SANITATION PERMIT �annPermit(Complete in Duplicate) <br /> Applica+ion is hereby <br /> � . <br /> 6o the Son Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> PreviousThis application is made in. compliance with County Ordinance No. 549. <br /> Contractor's Name_____r <br /> Installation will serve: Residence E]. Apartment'House E] Commercial F] Trailer Co�urt'E] Motel E] Other <br /> Number of livin; units: Number of beclroom� 1el. Number of baths/!�Lot siie -------------- <br /> ------------------------------------ <br /> Water supply". Public system El Community system E] Private BrOlDepA to Wafer'Table f <br /> Character of soil to a de A of 3 feeJ, Gravel E] Sandy Loam El Clay Loam E] Clay E] A o6e <br /> ' ' Mu6o: Yes [� No 94-""New Construction. Ye` g3 Nn '^ " ~TYPE � [ <br /> OF | SPECIFICATIONS: <br /> '(No septic'fank or cesspool permitted if public sewer is availa6le within 200 feet.) <br /> 14;m 4 N <br /> Dispos.al field: Distance from nearest well------------------D�stance from founclation-------------------�.Distance to nearest lot line--------------_ <br /> Seepag Pit: DistanIce to nea-re'st well---//47------Distance fro foundaf Distance to nearest lot line----------- <br /> ' hereby~ certify that ' '~`~ r'`r~'~~~^~ application and that the -~- 'ill~ be --~ in accordance -^' ~~' Joaquin^ County <br /> ordinances, State laws, and rules and' g I +*ons f the San Joaquin Local Health District.- <br /> R(Sign 21 . <br /> ------------------------------------------------------------- <br /> ze�of- �m in relation to �� bv��� p�.�*�."eplaced on m�m side).(Plot plan, showingm � � � <br /> location. ' <br /> ` | FOR DEPARTMENT USE ONLY J( <br /> ," . L(C^`.=` '.~CE .^" ".--'��i''--_''-'u�-�^�^ ---''---'--''''--' ~'`'�-�'-- n-^-~-"-'_-''- Y <br /> ----------------- <br /> REVIEWED 8Y--_-_-_---.-_`-----_---�-----_-..�_.-_--__. D�TE--._-��__-,-_________. / <br /> BU|LD|N6� PERMIT |SSUE[\-_---_--�--.-_.--.--.______'--._--- D�TE-._._'�'-.--------�_-. <br /> AKor*+�no and/or rocommendm+�oo�---------------_----_-..,--,-._�._.z^_-__._-_-_-._.-_-. ' <br /> ' ' <br /> '-__------''-'''-',-_'''---''----'-'''--''-''-_'-''-_----''_-'''-'''_-''-_.'-'--.-_'-__-_.'--_. <br /> � <br /> __------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- <br /> ----------I''�---------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------- -'''--'''-'''--'----'—''-''-'----'-' / <br /> ' <br /> FIN/\L INSPECTION --------------------------------------------- <br /> - -- Date-----:----'- -------------------------------------____ <br /> j SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> ^ <br /> /ao South American St=et ' 300 West Oak Street /sz Sycamore Street ow North "C' Sf=° <br /> Stv*kf" . California Lodi, California w"otew° California Tracy, cuof*=ia <br />�� ^� <br /> ES-9-2M Revised W-2100 <br />