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FOR OFFICE USE: <br /> ------ APPLICATION FOR SANITATION PERMIT Permit <br /> in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <br />---���� -/ LocalApplication is hereby made to the Son Joaquin Health District for a permit to construct and install the work herein described. <br /> This a!lication is made in complianci with County Ordinance No. 549. (-7,s-- oro - i <br /> --------------------- <br /> Installation will serve: Residence Q,,;-Apartment House Ej Commercial Trailer Court C] Motel 0 Other [I <br /> Number of living units: ...I--- Number of bedrooms of baths ---/.. Lot size --------- ------- <br /> Water Supply: Public system g--'Community system 0 Private E] Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand []-,.!Sravel [] Sandy Loam El Clay Loam Ei-t-l'ay El Adobe 0 Hardpan C1 <br /> Previous Application Made: (if yes,dote--------------------),,No E3---New Construction: Yes �o [:] FHA/VA- Yes [] No E�— <br /> |rrE OF INSTALLATION AND SrEC/r"CA/ Orm; , <br /> (No sepfic tank or cesspool permitted if pubric sewer is available within 200 feet.) <br /> S~p�c Tank: Distance from nn'n,"t �mU-~°���-'D|�onco from fnun6ution_,Z��---��u+o6oL-.- ..�~ <br /> No. ofxompurtmento- -----.... Liquid deR+ ------- 111-------------Capacity.----������ <br />� <br /> Disposal Field: Distance from nearest welr.."I-—-'---iDistance from fouoclmtion __5--a Distance to nearest "", <br /> -- Type of filter material.. �''Deo+ of filter material--/ 7o+u| length.................. <br /> ' i foun Distance ,o� lot ||na_-��-o�' �K�eepag Distance to near6st <br /> Number of pits'...-��--Lining materi 3bo' Dia meter- ------Depth........2-,,j................ <br />' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material ''-'---.-'--_'' �j <br /> Size: Diameter---.---------..Depth----------------------------------------------------Liquid Capacity------.---..'gaw. <br /> Privy` Distance from nearest well-------------------------- ----------------------Distance from nearest building--__'--------- <br /> [] Distance to nearest lot |�o'''''''-�'---''-'-'__---_--'-_''---__.---'-_'-----''--'-- <br /> - A \ <br /> Romn6e'l|ng and/or repairing :------------ ---------------------------------------------------------------------- ---------------------------------------------------------------------- <br /> -------------------------------------------------------- '-L_.__..__.---_----''-------'''--'-''--'---------------'----'------ <br /> i _ __________________-_|--'-_-_-_--- ~��--------'—''--------------'--''---'----- <br /> r .—_-___---__-_---_-__�_.-._-__�-^__-' � -'--.-�__-___-.__._-__''--__'--.-__.---.—. ` <br /> ' and that the work will be done in accordance with San Joaquin-County <br /> ordinances. State laws, and rules and regulations of the San Joaquin Lo-�al Health District. <br /> so side). <br /> (Pic+ p'r". Wrg size of lot, locafi�n of sys em in relation to wells. buildings, etc., can be placed on rever <br /> FOR DEPARTMENT USE ONLY) <br /> ------------------------- <br /> APPUCATlON ACCEPTED BY ' <br /> P :;:�9_-�_ _ ------------------- ---------/ / <br /> REVIEWED BY' / - — DATE <br /> BU|LD|N�' PERM[T |S6UED. ^�- ' ''--'----' ---'_---'__'___-________._ <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Syroet 12 4 Sycamore Street 205 West 9th Street <br /> xmckm" California Lodi,uwn"=ia Manteca,California Tracy,California <br /> `" v "xw"x" "'"° vw o'°. ="." <br /> ��� <br />