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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in <br /> " Duplicate) <br /> Date IssuedApplica-�ion is <br /> hereby made to the Son Joaquin Local Heo|H, District for u ' <br /> permit tocn""''"`' and install H,«*o� hherein 6o�,�*d/»� ap��ot�n is made io|� w�hCou <br /> JOB ADDRESS AND ATIO <br /> �4DO A T ------ ----------- <br /> _ _ k <br /> ..... TZ;_ '?0—--------- ------------ ------------------------------------------------------ Phone---- <br /> Address----------1� . T <br /> Installation will serve: Residence x Apartment Ho El Commercial F-1 Trailer Court F1 Motel 0 Other <br /> Number of living units:�,_j--- Number of bedrooms _1,_-_-11�umber of bafhs ----L Lot size --------�?PAJ ;71 1 <br /> Water Supply: Public system" El Community system El Private D Depth to Wafer Table _2--- ft. <br /> Character of soil fo' -a depth of 3 feet: Sand E] Gravel [] Sandy Loam [] Clay Loam Ej Clay F1 Aclobt;A��Harclpan E] <br /> Previous Application Made: Yes [] N�'X-T New Consfruc-ilon: Ye No El <br /> TYPE OF INSTALLATION AND SPECI CA IONS- <br /> (No septic tank o-r-cesspool permitted if public sewer is available within 200 feet.) <br /> Disposal Field: Distance from nearest well-----------------Distance from founclation-_--------------- Distance to nearest lot line----------------- <br /> Seepage Pit: Distance to nearest well----- ---- -Distance frop found�fion-------��_4�isfan <br /> __4fo nearest lot I' e <br /> Cesspool: D�sfance from nearest we'll-----------------Distance from foundation--------- --------Lining material_-----------/ <br /> Distance to nearest lot line------ <br /> Rem6cleling and/or repairing f�escrlbel:------- <br /> --------------------.-----.--.--_-------.-..-t-----------------' ' <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. Staf laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot-plan,-showing-size-of loti-location of-sys+ern-in relation to wells, buildings,.efc., can be.-placed-an-reverse <br /> FOR DEPARTMENT USE ONLY <br /> BUILDING PERMIT ISSUED <br /> --------'--' <br /> '----'--'-------'-''-'''''—'''-'''-----''---''''--'---''--''--''''--'''-'---'`--'--'-------'' <br /> '__--------__--._--------------------_--.---------__-_-_--------.-__---- <br /> ---'---'''''''--'---^'''—'''---''--'-''--'--''--'-'----''-''--''-''''-''-'----'''--' <br /> --''-'-'--''-'--_''''-_.''----_---_''--''-'-_''--'--''-'---'''----'--.'_-----_. <br /> � <br /> FINAL INSPECTION BY:................. '' Date--------P'....ff- <br /> ' ----'-''-'-- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /30 South American Street 300 West Oak Street /32 Sycamore Street m* North "C" Street <br /> %moktm. California Lodi, c*kfor'nia Manteca, California Yra*'. Ca|K*rn|* <br /> ^.9­9 °S°^",°"" <br /> - ' <br />