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� APPLICATION FOR SANITATION PERMIT <br /> ji in <br /> | <br /> Application is hereby made <br /> to� o Son Joaquin Local Health District for o permit to construct and install the work herein 6uaz|6e6. <br /> This application is made in c6mp|iunco with County Ordinance No. 549. <br /> JOB ADDRESS AND <br /> Installation will serve: Resicle'�nce EY Apartment House El Commercial El Trailer Court El Motel 0 Other El <br /> Number of living unit�: [h Number of bedrooms Number of baths Lot size----d- _0------------------------- <br /> Water Supply: Public syste�`n E,,M "Community system E] Pr;vate <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [-] Sandy Loam El Clay Loam I-] Clay El Adobe N( Hardpan <br /> TYPE OF INSTALLATION �ND SPECIFICATIONS: <br /> (No septic tank or ce�'spool permitted if public sewer is available within 200 feet.) <br />' <br /> Cesspool: Distance from nearest *ux_----_Distance from foundation----~-.--umn ----------------------------------- <br /> Lining mon, u/ � <br /> El ��o� D�m�net,r--------------------------------------Depth----------------------------------------------------- <br /> Privy: Distance: nz 'Well Distance from nearest building <br /> Seepage Pit: Distance'fo nearest well-----/./--f---I----Distance_from foundation----- Distance to nearest lot line- <br /> Number o"f pits-------/_---------Lining material--iXf-I"_ _ S-Size: Diameter_w <br /> Disposal Field: Distance" <br />� | of filter material ue9m of filter material <br /> Remodeling and/or repairing (describe):------- <br /> ---_-___.--'._-_�-.-7 --_--___-_-._____'___-___'_____________.--_.-__' <br />� __'---_____.'-''--- -'-'__.----__.-_-'-_''-_'''-_-''-_.'-__'__.'-_-.'''-- ---_.__'_ <br />' <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />" <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 />� <br />� <br />" <br /> APPLICATION ACCEPTB} -''-_.'--------� / '''-_.''' D/�E''' '-_____-.. <br /> REVIEWEDBY--------------------------------------------------------------------------------------------- DATE-------------}�.����-�_..._____ <br />` <br /> BUILDING PERMIT ISSUED-;' -..___-__-----------__-''-_-_- DATE_---__--' --_-______ <br /> Alterations and/or recommeK6afionv,--------------------------------------------------------------------------------------_-------------------------------------------------------------------- <br /> ~ <br /> -----'------''--------'--------''----'----'--'-'---------------''---------------'--' <br />� -----_---_.----'----..!--_------.-----__,-.--__-------'__-____--__-.------_----_---_-----.---.. <br /> ' -__--� �-----__..._��'..__--'-__'-__-- -_�_--_-'-_-.''__-'--_-__-___._----. <br /> -------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- <br /> PERMIT N,—A0.d---------- |,SUED----------- -----------(Date) RN/\L INSPECTION BY:--- <br /> Y � ---------------------- <br /> ------------------ <br /> Date-_---__-..^-------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> -----_'------.--__--__-_- <br /> SANJOAQU|NDOCALHEALTH0STR|CT <br /> " <br /> 130 South American Street <br /> � <br /> �� �m <br /> ' U � . California <br /> ES -9-2w9-50W-/639 � <br />