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APPLICATION FOR SANITATION PERMIT ."u -�.x-:......_' <br /> r~~ 'r-- in Duplicate)' <br /> Date Issued ' <br /> \" mo�-ca -� - he,a6v made to the Gun Joaquin Local Health Di�r|c+ for u permit to construct and install the work herein described.app|ication |smade in compliance with Cou� (��� N� �� <br /> ~ <br /> ' ~ ' <br /> .' - <br /> ' <br /> ^~.. ~. - --'_--.--..-'_-'---.'--'_----- <br /> Controcto,o -------(-^�p__m��^,����----_'_---_--__--�'--. ,"v"",^��°.*�-'�"���� <br /> Installation will serve: Residence Apartment House E] Commercial Ej Trailer Court E] Motel [:] Other � <br /> Number ofliving units:,--/--- Number of bedrooms __::!2t-Number of 6mH,, ��-.. Lot size --. ..A .----- <br /> Water Supply: Public system 01 Community system El Private [I Depth to Water Table ./_Veff. <br /> Character of omU to odaofh of 3 feet: SomJ E] Gravel E] Sandy Loam E] Clay Loom [] [1oy [] Ado6e'2�_Hu,600n [] <br /> Previous Application k1mdu: Yes E] No K Now Construction: Yes 0-No 0 _ <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (Nm septic tank or cesspool pe,n`� R � <br /> �w� public YsmvmlknhJ� whin 200 feet.) � <br /> Septic Tank: . from nearest'well-tVdAC-Distance from foundation---)6./ | <br /> _- 1 ' <br /> ------ <br /> Disposal Fiu|d: Distance from nd we|WA7.jazisfafrom-fou dti <br /> �] --- <br /> Number of lines - Length of each1 <br /> Type of filter ...Depth of <br />, <br /> Seepage Pit: Distance to neure, ^��*��xe`�Distance - ��� <br /> ' 2---u/s`unco to nearestlot / <br /> Number of pits------/--��� Diameter-_ -Z1-15,-Dop+h-.- ------------ -~ <br /> ' ' v <br /> Cesspool: Distance from nearest well----- fn6n foun6cdimn--- ----------- --- Lining material-- y^ <br /> ��a� Diameter---.-----���--.�Doot -----_._-----�---L|qu/6 Cup�dt�---------.gu|�. -, <br /> -- Y� <br /> �Privy: D;danco from nmor-°s+ well-------------------------------------- -------- Dish,nce froT nearest building--------------- `\ <br /> �El Distance to nearest lot line--------- --------------------------------------------------------__---___..--_____._______.. <br /> � . <br /> Romo6eling and/or repairing (describe ------------------------------------:-------------------:--------- -''--'--'-_--------------------------------------------------------- <br /> -------------------------------------'-----------'---'----'-'-----''--'--'-'-'--'---'''-''--''-----''----- <br /> ^ <br /> --'-''---'---------------'--'------'----'------------'''-'-------''--'--'-'-'--'—' <br /> --''--'-''-'--'.-'''-'''-_-''----_--_--_---.-'--------'_----'--''--''---''-__-'-'-'--''-- <br /> re6 this application and that the work will be done in accordance with San Joaquin County ' <br /> ordinances, S+at ws, and rules and 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 /> FOR DEPARTMENT USE ONLY <br /> ---'-------------------------------------------------------'-''---'---'--'''----- <br /> ..''--._----------._--------------.__---._--------_-_----'--_-._-.-_-_--- , <br /> ------------------------------''------- -'-''''-'''' ----------------------- ------ ----------------------------------------------------------------------------------------------- ------------------- . <br /> _---_------___----------_-----_�-_-------_-----__-------- ---------- ------------------------ ------------------------------------------------ <br /> � <br /> FINAL INSPECTION BY:. ._- Date--11-_��----------------- ------------- ------------- ' <br /> SAN JOAQW|N LOCAL HEALTH DISTRICT <br /> /30 South America" street 300 West Oak Street /32 Sycerno= street ww North 'C" Street <br /> e" u"o. California Lod(. California Manteca, California Tracy, California <br /> - y <br /> .,~, <br />