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- � <br /> APPLICATION FOR SANITATION PERMIT 10tPermifNo .. ------------- <br /> ' ^ k�omo�f� 2n Omukcat* _*�-�� <br /> ----- <br /> (Complete -'--~/ Dofo |smo6 �['��i-���-� <br /> ' - <br /> Application is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> This applicatiRn is mad;,in c� pliance with County Ordinance No. 549. <br /> mp <br /> JOB ADDROSUA4ND) "JON- --------- ---------- ----- ----------- ---------------- <br /> 91 V <br /> Installation will serve: esid nc Apartment House E] Commercial E] Trailer Court E] Motel ther .2 <br /> Water Supply: Public system El Cor�munity system [I Private [��Ipth to Water Table <br /> Character of soil to a depth of 3 feet: Sand [] Gravel 0 Sandy Loam Clay Loam Clay El Adobe F] Hardpan <br /> Previous Application Made: Yes [] No [R-""New Construction: Yes D No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:- <br /> `~ `'(Nm'�� �,� 6k -~� H <br /> - | -- ' f�J1����6|iis O b| wifhi 200 + t) ' <br /> Septic gaTank: D hn �� n -���= uuaffoundation <br /> Di, io|d: Distance f st | u. tnca f foundationu�ance to nearest / r <br /> ETLength of each line-- I-IAV- <br /> Number of lines-- <br /> Type oT --- Total length <br /> Seepage Pit: Disfonce to nearest well-----------------------Distance from foundation----_--_Distance ru nearest lot ""e-----.. <br /> El Number of pits-----------------------Uning material----------------------- Diameter-----------------------Depth---- -------------------------- <br /> Distance from neuro` well_-''---D�+mnxnfrom foundation----- --'''-�n|ng matoroL_''� ----------- ---------- <br /> Cesspool: Size: Diameter------------------------------------- ---------------------------------------------- ------Liquid Capacity-------------- ---------gu|s- <br /> Privy: Distance from n'eorest well -------------------------------------------Distance from nearest building--_--��-_-_--- | <br /> ElDistance to nearest lot line------------ ------------------------------------------------------------------------------------------------- -----------------___- � <br /> Remo6u|ing and/or repairing fdoscri6e\:--------- ------ -------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------ -------------------------------- <br /> ------------------------ ----------------_-_-__.------------------------------------------------------------------------------------------------- ----------------------------------------------------- <br /> ------------------------ ------------------------------------------------------------------------------------------------------------------------------------------ - -----------------------.----------------------- <br /> - <br /> I hereby certify that I have prepiiired this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State, la and rules and'iegulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relation r to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE. ONLY <br /> � <br /> 'AT <br /> -- --------------------- -----?------------ <br /> ou/uuvvc, rEn,°./ .="""° ' <br />^ '..~~.~- and/or` recommendations-- ----------------- <br /> AY.YU I ------------------- ----------------------------------------- <br /> 7 � -------------------------------- <br /> M - ro SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> /30 south American Sfreef 300 West Oat sfreat mx Sycamore Streef aw Nor+h "C" Sfreef . <br /> St""kf"". California Lodi, California Mwo*uuu. California Tracy, California <br /> ES-9-2M /0u2 n.°aea vv-2100 <br />