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C/ APPLICATION FOR SANITATION PERMIT Pdm i t N o. <br /> (Complete in Duplicate) 0"f Date Issued <br /> ;v 8a r, .J.'. <br /> �App'pplica�ion is her by m do to the San Joaquin Local Health D�strict for a permit fo consfruc.f'andiinsfall.-fherwork-berein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIO Z <br /> &-- --------- <br /> Phone <br /> Installation will serve: Residence El Apartment House E�Jmmercial D Trailer Court Motel [I Other E] <br /> Number of living units: .s Num er SjoWth <br /> Priv <br /> Water Supply: Public system E] Community sysfem Private ArooDepth to Wafer Table.:!Fo. - ff. <br /> 7t: <br /> Character of so;l to a depth of 3 feet: Sand El Gravel Sandy Loam Clay El Adobe �Har pan El <br /> Previous Application Made: Yes [] No 4000,New Construction: Yes jo _��lay Loam Ej <br /> r-No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or ce'sspool permitted if public sewer is available within 200 feet.) <br /> Sepfic Tank: Distance from nearest vve�IL�__C_Distance xclafion-----/Jf---- <br /> /M 0 Materi <br /> Disposal Field: -Distance from nearest weIIA6 -Dist ce Afrom foundation--- --- Distance to nearest lot line--e------- <br /> 1�04-Length of each line__0114 lVa. Width of french,--,,vp�v <br /> . -------Total long <br /> -------------------- <br /> Seepage Pit! Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------z_____Lining material <br /> Remodeling and/or repairing (describe.)-------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, pincL rules a;n:d,'�rulafiy of the�an Joaquin Local_!­�alfh District. <br /> ------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, e+c.t can be placed on reverse side). <br /> ,.fOR.D,E�-ARTMENT Up ONLY <br /> ^ <br /> APPLICATION ACCEPTED BY--------------m��_'J�-- - DATE--.4�� <br /> |EV�ED BY_-__-._-._--..�.y'--�^��_/� -----'~.-'^'--'''----'—' DATE---x--'r�r---'--'----'- � <br /> BU|LO|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE'.__.''---____''_________ � <br /> Alterations and/or recommendations -------_ -------------- -------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------'--�—'-------'---------'-----'-'-'---------------'--' | <br /> -_--_-___---_--_---_---.----___._-^.-_-_-_-_---_'-_-_-----_____.-~-_..__.--__ <br /> -----'--'--'----''''''''''''''''''----''--��--''-----�------'''�-�--�-��---''--'--''--'-------r-' <br /> ---'---._---._--._-------.. .-- .- -------------------- ---------------------------------------__-._-_____-_--__. � <br /> Q�� � <br /> HNAL INSPECTION BY�----.7,��-�' ���{-�-~._-�_ �o�� 7^f ��^ ��~-�=� <br /> 3ANJC)AQUiN LOCAL HEALTH DISfRiCT <br /> /oz South American Street 300 West oak Street 132 Sycamore Street "*h "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California - <br /> ° <br /> sS-7--2w 8-5/ m*ue6 vv-2100 <br /> � <br />