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APPLICATION FOR SANITATION PERMIT Permit Mn' <br /> � <br /> (Complete in Duplicate) Date Issued . <br /> Application is <br /> y made to the San JoaquinL*calHealthOist6c+for apermit+oconstruct and install the work herein described. <br /> This application iomade in-compliance with County O <br /> / �� �� � <br /> � �� v� �m --. ���~�C��4....................... . <br /> � 41 <br /> � <br /> Installation will serve; Apartment House O (�mmn��| � 7�i|ur C�� � � C�or � <br /> ' f6�6 �� Number of '� Lp+ � �~/� ^ �� �^ .....................umber of size <br /> ' Water Supply: Public system Community system 0 Private E] Depth to Water Tablo -_ ft. <br /> Character of sail to a depth of feet: San <br /> d GravelE] Sandy Clay Loam[] C|uy[] Adobe��ZHardpan [] <br /> Pmwiou* App�cafmn Made: Yes [I No Condrucfion: Yes [R- No 0 ' <br /> n° | <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; <br /> (Nmvnpfic tank or cesspool permittedif public sewer is availablenn` uwwfeet.) <br /> . <br /> �. Seic Yank: from nearest well---- Distanc + / ���� w ' �` �� <br /> WNo. o` cumpor�mon�x---`-� - �/za-..� ,5Z 6d Liquid-depthD eld: Distance from nearest well Distance from + u � <br /> of each line_ . v/um cn �en <br /> , mt^| length <br /> � ...................... <br /> -�..Nvm6*r of |i <br /> Type offiHnrmu+a6a a�h of Pilfer mm+u�uL' � <br /> i\ <br /> , <br /> � 6wnp*gm Pit: Distance to nearest well --_..............D�,+ancn from foundation................_D|st*nouh, nearest lot line------------------ <br /> Number <br /> �---_'_ ' <br /> [] Nun6=roJ pit,------_.--_-Lining material _- -------------Size: Diomptec--_...-_-'-Dept ........................... <br /> : Distance from nnu�o w�L'--__-D�tuncof*x^ 6mn6wt�n'_-'----��ng mu+�huL----''-----_�_ <br /> Liquid ` <br /> ' [] 3hm: D�metec-_-__.-_--'--'--0ep�--_-'_'_---_-_----- . ��pac��_--�..__-_'�a� �� <br /> Privy » Distance from nearest weli-.:-------------------.......................Distance from nearest building......................... <br /> [l Distance to nearest lot line.................... --------------------............. .......------------------------- -------------------' <br /> � Romo6w|ng and/or repairing ;......................--'---.-'____.__'' ........................ .... .......................----------............. <br /> __ ` <br /> ___---__- <br /> � __-_---'-'__-'--__-'_--'-_-_''_-__-_'__-'_-------............................................-_'_~_-_--.-_---'_.--'--�-- <br /> -_--_-'-___'_-'___-_____----__'-----___-__..___--___'-__----_--_--'__--._----_-^..^__-' <br /> I hereby certify that I have red Ais application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. <br /> .S i-n e d)'- ' 6_101, <br /> , <br /> BY:..............................................._.............................................................................(Title)--.---------------'_-_-- <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 /> E ................................ .......................11- �/S, <br /> � Alterations and/or recommendations:........-------------------............. --------------------------------------`..................---------------------------------- ........_--------- <br /> � <br /> -------------- <br /> --------------- <br /> ------ <br /> ----------- <br /> --__-._---------------- <br /> ---------------------- <br /> ---------------- <br /> _-_-_--_-_--- -- ----------------------------------------- <br /> � -'_-__--__-----__.`_--_-'_--__' '-_-_-'__�-'---__----_-_...__--__-___.._.__-' <br /> / <br /> ----------------------------------------------..............................--` ..............................-------`--` - - --------`' <br /> '---�_--__----_---____---_-_-------'------_----__.---_-__----_.--_—_-_-'-'_--_.__._--' <br /> V.-le <br /> RN/\L INSPECTION 8Y�----.\�Q.'.. ----_ Do+o--------------- ----------- <br /> � SAN JOAQU|N LOCAL HEALTH DISTRICT � <br /> ' <br /> 130 South American Street 300 West IDA o*e*+ /xz Sycamore s*we m/4 w**h "C"Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> / <br /> ES--9-2M B-n/ x°./`*u v/'z/oo <br />