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1-uwow1[EUSE, <br /> j(;-)'- APPLICATION FOR SANITATION PERMIT Permit No. _.�LLS........... <br /> (Complete in,Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Applic ion is hereby made to the San Joaquin Local Health District for a permit to construct and,-i all the work herein described. <br /> at <br /> This application is made in compliance with Countyprdinance No 549 <br /> /119 ___­----------- ----------- --- 4---................................................... <br /> Installation will serve: Residence Mg<partment House [] Commercial E] Trailer Court [:] Motel [I Other 0 <br /> Number of living units: _/---- Number of bedrooms-J. Number of baths ./. Lot size ___7_j_e^ <br /> Water Supply; Public --,-munity system <br /> system, 4--corn <br /> -1 Private [-] Depth to Water Table Ceft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam F] Clay Loam El Clay [3 Ad <br /> Previous Application Made: (if yes,clate---------------- ---I No El New Construction: Yes E] No gj��FHA/VA: Yes E] No E] <br /> (No se fie tank or cesspool permitted if public sewer is available within 2DO feet.) <br /> S T Distance from nearest well---- istance from foundation---------------_--Material------- <br /> -------------------------- <br /> 0 00 <br /> Disposal Field: Distance from neare f well.-140- - .- istance from foundation-----40-1...Distance to nearest lot line---- <br /> Number of lines------ --- ----- Length of each line---/40-- ..Width of trench <br /> Seepage Pit: Distance to nearest well ----- 9 #41 <br /> -------------- <br /> --Distance from foundation.___,_2-,,.0_/...Distance to nearest lot line------ <br /> Distance to nearest- lot line------------ <br /> ...................------------------------------------------------ <br /> -�'-''---.-----_------_----------._.-_----.------..-------.---.. <br /> '----------__._----_---..'�_-__.__-.__-__-'-_—.__._-''--___.-._-._--.----_--_---.---- <br /> . � <br /> '------'—'---'---''--''-------'-----'-------------'''--'--'---------- --' <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with S�in Joaquin County <br /> ordinance <br /> w <br /> ~~,, <br /> By:-__..________ .______.. U - ' -----------`____~~~_,~. ~°.~./ <br /> �&� o�n, o�� w� �� kwcm�wn�mf ^yo�o� ;n relation �`�|6� ' u�' be-'--'�'---------------- <br /> ` '_� -~_.= ���� mm n���� �� p�� wnreverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION�ACCEPTED BY <br /> --------------------------------- <br /> ----`G ' ^'`'~'' ISSUED------------ --------------------- ---------------------- -------------------------------------- DATE <br /> --__.__.___.__..',_.___ � <br /> Alteration" ----- | <br /> ` - f'=��'' '^=��^s"�-'�:�*=-��"--�����°=���= '' <br /> --_'_-.._----_-------_-.---_-._---._---_—_-----.....--__..._-.-_— �. <br /> '--'--------------------- -----------------''''-'-''-'''-''—'---''-'-''---''--'''-'--''—''--''--'''-''---'-'-''-- <br /> ' -' <br /> '-'-'-'---'----'- ............... ---------------------- '-........ ----------'' -------------------------- <br /> FINAL <br /> ----_''-- <br /> RNAL INSPECTION BY:- ''--' Duto'-'''- -'--'---''' <br /> ^' SAN JOAQUIN LOCAL HEALTH DISTRICT / <br /> 130 South American Street 300 West Oak Street vn*Sycamore Street 205 West 91h street <br /> Stockton,California . Lodi,California Manteca,California Tracy,California <br /> ou v REVISED w-8vn° m'mATLAS � <br /> _^ <br /> -- - <br />