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- <br />� APPLICATION FOR SANITATION PERMIT Permit No. <br />K <br />(Complete in Oup|imm6w) <br />Dn+o |uouad ----------- <br />Applica-1-ion is hereby <br />' <br />' made to the San Joaquin Local Health District for a perm' to construct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. <br />JOB ADDRESS A D ��TION -------- - e__. - ------------------------------- <br />Installation will serve: Residence Apartment House E] Commercial 0 Trailer Court El Motel 0 Other E] <br />Number of living units: -- ---- Number of bedrooms Number of baths Lot size --------------- <br />Wafer Supply: Public syste K Community system [] Private E] Depth to Water Tableio�ft, <br />Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam E] Clay Loam El Clay El Aclo�< Hardpan E] Q <br />Previous Application Made: Yes E) NoX New Construction: Ye�,�, [:1 �Ikj <br />TYPE OF INSTALLATION AND SPECIFICATIONS: "A*J <br />(No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) 01 <br />Septic Tank: Distance from nearesi well__,v_,kj�--,Disfance' <br />Nq. ofcomnpur+mnnt,--42------------------ Sizo-X-Liquicl 6opfh..��.�r.Cup+y <br />Dioposa| Field: Distance fromnearest | <br />' <br />Number �f lines - <br />.. ^~.�.. .. ~.~ ..~ <br />^ <br />Type of filterDepth of filter | <br />Seo Pit: Dist U <br />Cesspool: Distance fro'_ nearest_ _.--'-_'--_-~ ._.. foundation- _- material ^'---''-''--'__� <br />171 Size: Diameter�-'-��-��'-��_'.Dop+h ----------------------------------------------------- Liquid Capacity -''----'---.gmls. <br />Privy: Distance from nearest well ---------- ------------------------------------ Distonoa from nearest 6ui|6iog------ :--------._-- <br />El Distance to nearest lo* line __--'''-'''-''----------'--_----'-''''__.----�'-'---'--- <br />Rnmo6v|ing and/or repairing (describe):.. --�--_____-____.-_----'----_-_-._____________ <br />'--'----'''--''--'--''--'-'---''--''---''---''--'-----''--'-----'--''--'''''--'------'--'---'- K <br />----````-`-````-`---`-``--'`-`---'------'----------------'----'------------------'hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countyordinances. Sfa!+ ws, "andl rulas and io s of the San Joaquin Local Health District.(Signed) ....... ------ ----- --- ------ --- ------ ----------------- --------- ----------------------------------------------- �_ner Xan(Plot plan. showing s e of lo , locfaiion of system in relafion to wells, buildings, etc., can be Pla an reversesFOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY. --_-------.------_---_-__-_.D/H' _---________ <br />KENGVVB] BY ------------------------------ <br />DU/LD|N��PERMIT ISSUED '-- =-�''''-'''-_-'---'-'_-''-'''----'''--.- <br />U <br />DAT/E'/--------------------------------------- <br />Alterations <br />_ <br />__ <br />___ <br />__ <br />AKoraGmnuan6/nr,owwnmenJatinnw: ���--..._-.--.--.---_-�.-.-.�_.-.---.--__- <br />-----'''-'---------_-.'''-''''-''''_---'''-''----'__''--'^-'-'-----'''''-'_--_-----------.'- <br />'--'----------'---'-----------'------------'--------'--'—'-------'---' <br />'-''-'----'-''-'—''-''�-''- <br />------------------ ----------------------------- '-'';�-''-''___ <br />FINAL INSPECTION BY�-------��! <br />� <br />------------- <br />/'-..--------__--_—. <br />SAN JOAQ0NLOCAL HEALTH DISTRICT <br />/so South American �� <br />300 West Oak Street oz Sycamore Street <br />ow North "C" Street <br />Stockton, California <br />Lodi, California Manteca, California <br />Tracy, California <br />