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� <br /> APPLICATION FOR SANITATION PERMIT <br /> in Duplicate) <br /> Application is knre6v mo6o to the Son Joaquin Local Health Dist ricf for u permit to construct and install the work herein described. <br /> �This application |s made incompliance with County Ordinance No 649 ` <br /> ( <br /> ouo nuuncaS AND ( <br /> \ <br /> Installation will serve: Residence VApartmenf House E] Commercial E] Trailer Court E] Mofel E] Other E] <br /> Number of living units: VNumber of bedrooms 2- Number of bafhs Ej Lot size--------- ------------------------------ <br /> Wafer Supply: Public system �?/Communlfy sysfernEj Private El I NN <br /> Character of soil to a depth of 3 feet: Sand [] Grave) E] Sandy Loam E] Clay Loam E] Clay D Adobe)< Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu6lic sewer is available within 200 feet.) <br /> Cessfool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ <br /> Re/n: ~~Disf.* :f"zm^nnunysf,wmu-_'�`�-.Dista <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counf�y <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY | <br />. <br /> APPLICATION ___ -- BY_-_---.------' / i <br />� <br /> REVIEWED BY---------- --------------------------------------------------------------------------'' -��-�''--''-- DATE_''---_'-'''-'___'--'-'-' <br /> 8U|UJ|NG PERMIT ISSUED------------------------------------------------------------ --------------------------------------- DATE------------------------------------------------------------- j <br /> Alterations / <br /> PERMIT No-'���../-_.. ISSUED-'/�. �w^-.�_/'�_.-(Do*� HN/\L INSPECTION DY�'.u������-.�----'_-____ � <br /> Date------------------ ---------------- <br /> SAN <br /> �-_-_-SAN JOAQU|N LOCAL HEALTH DISTRICT ` <br /> 130 South American Street <br /> / <br />� w� -o�~~�on. California <br /> \ / | <br />