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APPLICATION FOR SANITATION PERMIT Permit No. <br /> k�mo�f � Duplicate)(Complete '—` Dute Issued ����'1 <br /> / / <br /> Application is hereby made to the San Joaquin Local Health District for u permit to construct and install the work herein clescrib <br /> This application is made in mmpjiano: with County Ordinance No. �9. ^ 45 <br /> . ' <br /> JOB ADDRESS AN ATION... <br /> ------ -------Zone----------------------------------- <br /> ------------ <br /> Installation will serve: Residence E] Apartment House 0 Commercial E] Trailer Court 0 Motel El Other b//0L ' <br /> Number of living unit,: -------- Number ofbedrooms --- Number of baths -------- Lot size -----I---- --------' <br /> Water Supply: .Pu6|ic system E] Community system El Private E] Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: S Gravel � Loam El Clay 0 �o� 0 <br /> u��n <br /> H _Hardpan <br /> ApplicationMade: Yo, [] No � Na* Construction: Yes ;'-t EF [� <br /> TYPE C}FINSTALLATION AND SPECIFICATIONS: <br /> - (Nn septic tank o,'ces»pno| permitted if public is available �m�|o � h|n 200 feet.) <br /> Septic Tank: Distance from nearest �JP" Distance from foundation -)�]-/.1~-Material ..QAC-..e�~xC.1------------ <br /> �0 <br /> No. ofcompor+man+s-''3----..Sizn' �'&.�»�G.A�---�quiJ6epfk--- �./---..��o .adty. --.- <br /> Dis ' *| Field- Distance from nearestwe|| -^ --Di`tuncv from foundotion-A..~.-"-..Di,tonce to nearest lot knm'^:5­7'-r-. <br /> Mom6nr of lines------- -3-------------------Length of each line_ �l----_-Width cffn,nc6 Ry-° <br /> � Type of filter nnu+ohvl--.. c--------Depth of filter mv+eria|.. �_-Total <br /> ------- <br /> Seepage Pit' Distance to nearest well '''_-'-_-Distance from foundation--------------------Distance to nearest lot line-v---°-- <br /> [1 Number of pif`----------------------Lining material-----------------------Size: Diameter.__---..Depth-----.-----. <br /> Ceepoo|: Distance from nearest well .--_-'Distance from foundation ---------------Lining mnforiuL—.---.----'_ <br /> [l Size0 Depth id gals. <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 law_s�,and rules idr-egulations of the San Joaquin Local Health District. <br /> -----Vo <br /> Ct. I a system in relation to well Id <br /> (Plot plan, showing size of I tion of s, bui ienc., can be placed on reverse side). <br /> I th FOR DEPARTMENT USE ONLY <br /> BU|L0NGPERMIT ISSUED------------------------------------------------------ -----_-------------------------------------- DATE..-------._----_____ <br /> Afferm+ionsmnJ/orrecommenda+ions:----_—.--_-._---_----__---_-..___.__-._ --_-_'_-_.--__-_- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------ '-'''-'''---''-'''-_-''----'''-'''_-'''-_''_'-'-''-'-' <br /> --__-----__---_---_---_____---__-----__--- _---___------------_����___�--_��_����_-----_��_���_��---_-----_�������_---_ <br /> / -------- <br /> FINAL |NlPEI�T|(}N BY�-.. __--..��-----_- Da+o---..�..��.����-.- .~�._---_.--- <br /> ^ ` � <br /> SANJOAQU|NLOCAL HEALTH DISTRICT <br /> /m South American Street 000West Oak Street /32 Sycamore Street ow North ^o^ Street <br /> St=ktv", California L*d/, California Manteca, California 7w"» California <br /> ES-9-2w n°./,°v 1.57 rp.cn. <br />