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FOR OFFICE/U$E: <br /> �` �� `~ . ` =, _ � " . ' <br /> ~ ^ � ' — No. <br /> � APPLIC��TI���� 'F���� SANITATION PERMIT <br /> ' ' (Complete in Duplicate) Dmfm Issued -//���'3.. ~ <br /> ------------- This Permit Expires 1 Year From Date Issued <br />--------------------------- <br /> Appioy+ionbhereby made tothe San Joaquin LocalHealth Dist r|ctfor opermit +oconstruct and install the work herein described. <br /> This application inmade inoomp|iancewKhCounty {}n6|nonce No. 549. <br /> ' O ~�'^�� ------- <br /> JOB ADDRESS �AN <br /> T,- X4 - <br /> Installation will serve: Resider1ce g]'_*Apartment House [] Commercial C] Trailer Court [] Motel [3 Other 0 <br /> Number of living units: _/---- Number of bedrooms -,?-. Number of baths -./-- Lot size 11ef!X100�4 <br /> Water Supply: Public system 2--tommunity system E] Private [] Depth to Water Table lvp- ft. <br /> Character of so*sl to a depth of 3 feet: Sand E3 Gravel E] Sandy Loom [I Clay Loom [] Clay El Adobe Er-'Hardpan C1 <br /> Previous Application nwmom; yryeo'nonw--------------------/ No E] ,"e= .."",".,.~.. .~. R .,. 1 FHA/VA: Y_ [~ No -_ ^ <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: ' <br /> /No septic tank or cesspool permitted ifLpublic sewer is available within 200 feet.) ` <br /> Septic Tank- Distance from reu ~el| M ~ 0e <br /> Capacity <br /> mx~~ <br /> Disposal Field: [� from ui,�m from fnonuu, - <br /> mv Number— of lin'----'— LengthWid ..�,� <br /> ii <br /> Ir <br /> ~.~,_ '. Distance-_ to _nearest . . ' �� � ., . <br /> IE <br /> Cesspool: Distance from nearest well.................Distance .... foundation_ -------------------- -Lining material-_ ----- <br /> [] Sizo/ Diameter-------------------------------------- -.__--..__.-._-------r_L�u� t�___._._'gm�. <br /> Priv : Distance from noorno veU----------_-.. --Di�uncm from nearest6uUd�g .--'__---'._--- <br /> ' Distance hnnearest lot line------------ ----------------------------------------------------- -..............----------­--­''-''--''-'--''-' <br /> Remodeling and/or repairing (6n*z|be):---------------------------------------...................------------------------------------- '__.-_..__._____-_--__ �- <br /> '''------'--'-'--------'---'---'----'---'-----'''---------'--'-'-'---'----'-------''----' <br /> ---------'------'--'-----------'------------'—''------'--'----''---------''------'---'-------' <br /> ---------'-''----'-----''---------'------------'------''---------------'--'-'-------' <br /> h6thnapplication6 that thwork will be done in accordancewith San County <br /> ordinances,7flaws, and rules and regul ilons. of the San Joaquin Local Health District. <br /> _a------�rier and/or Contractor) <br /> (Plot plan. showing size of lot, locatVan of system in relatipo wells, buildings, etc., can be placed on reverse side). <br /> � <br /> FOR DEWTMENT USE ONLY <br /> / ------------------------------- ------- <br /> ------._--''------'--'-'---------'-`-------'------''------- --------'---------'--''---` <br /> _-'-'---''-'''--_''-__''--'—'-'-_.-'''---''-'''--''_--''--'--'-''­------­-------------- <br /> ------------ ........................... <br /> '.''-'-_----_-----_ ..............._.........._._­------------- ---- <br /> '''---''--'''-'''''-'--- ----------'--'-'-''''- -'-- <br /> RNAL INSPECTION BY. <br /> Y ' uu,m <br /> ''-''-'---------------------------- <br /> SAN <br /> '--.-''--- <br /> SANJOAQU|N LOCAL HEALTH DIST' <br /> cT <br /> - <br /> 130 South American Street uwwWest Oak Street 124 Sycamore Street uoxWest 9,oStreet <br /> Stockton,California Lodi,California Manteca,California /,w^y,California <br /> "° 9 ^xw"v" "'"p nm u'°. ",^^, <br />