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Y . <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ~ <br /> (Complete inDuplicate) � �� � <br /> Date Issued - .. ------- <br /> Application hereby <br /> mode to the Sun Joaquin Local Health QistHcf for a permit to construct and install the k herein described. � <br /> JOB ADDRESS <br /> ------------ <br /> Installation will serve: Residence Apartment House [-] Commercial [] Trailer Court [] Motel El Other El <br /> Water Supply: Public system E] Community system F] Private E�( Depth to Wafer Table _-.5-077, <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El �Clay Loam El Clay [:] Adobe Hardpan <br /> Previous Application Made: Yes [] NoK New Construcfion: Yes No [:] FHA/VA: Yes No <br /> TYPE OF INSTALLATION AND.SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 209-feef.) <br /> ardpa <br /> Septic.Tank: Distance from nearest well- ----Distance'ro ----- _0------ ------------- <br /> Disposal Field: D;sfance from nearest well DistanIce rom foundafion--,?6---4�/-"-Distance to nearest ]of <br /> Number of lines- Length of each <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------------\:T <br /> Cesspooi Distance from nearest well Distance from foundationLining tu i | <br /> ~---Liquid Ca. . ~qa <br /> __ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co u n y <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> p�nodr�_. ----_--_-.--_._---_'_---(Owner and/or <br /> '~~'_-� �- ' <br /> `___-__.--__-_---_-._-_-_--_-__..__.-._-__..-_^..le)°---__---.-_--'_---_ ---- <br /> (Plot plan, showing size of lot. location of system in relation to wells, buildings, etc., can be placed on reverse side). ' <br /> FOR DEPARTMENT USE ONLY <br /> ~�. ! <br /> KEV|E\�ED 0L'-----.'--.-_'---'- � <br /> BUILDING PERMIT ISSUED-------------------------------------- ---------------------------- DATE'------__'--- ----------------- <br /> AKo,u+iono and/or recommendations:------------------------- ------------------------------------------------------------------------------------------------------------.---------------------- <br /> ---------------------------------------------------------------------- _------_--_---_-.__-_---'-_.__---_-_-__-___'-__.- <br /> -'-'--'---''--'--'---''---''--'''-''----'''--''--''--''--''''---'--'''---''--''-'------'------' <br /> ---_-___---'_-_---_---_-----_._---_._____-_--.__-_-._-__--.- ------------------- <br /> ------------------------------------ <br /> ._-_.- <br /> ---''--'-_-,--'-'--''-'-'' '-'-''--''''��'-'------''''-'''--._-----'-- <br /> 6_- <br /> � � __FiN/\L |NSPECTON BY� ^ �� �~�^ Do�� � �� «� �. �----.��--------------. , ----. -.^-----����--.��------.` <br /> SAN JOAQUlNLOCAL HEALTH DISTRICT <br /> � <br /> oo so.m *="rico" str°of 300 West Oak Street |xo Sycamore Street ow worth "C" Street <br /> mv"kt*". California Lodi, California Manteca, California nn,y. California <br /> ES-9-2w ' x°.aed 1'57 p.pcu <br />