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PLICATION FOR SANITATION Pl,.KMI it No. <br /> 7-1 (Complete in Duplicate) TA Aperm <br /> 149 Le Issued <br /> Applicati ereby made to the San Joaquin Local Health District for a permit to construct and tall the r herein described. <br /> i ation is made in compliance with County Ordinance No. 549. <br /> Installation will serve: Residence E] Apartment House [] Commercial E] Trailer Court E] Motel E] Of her <br /> Number ofliving units: Number ofbedrooms -------- Number of baths --------- Lot size <br /> / Water Supply: Public system El'(f Community system El Private/~� Depth to Water Table .�*t. <br /> / <br /> Character of moil to m depth of 3 feet: Sand E] Gravel [] Sandy Loam El Cloy Loam El Clay E] Adobe 4 Hardpan 0 <br /> Previous Application Made: Ye, ' Construction: Yo, No E] Yoo [] No 11� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> /No septicf k or'cesspool permitted if b <br /> , ��� <br /> . k �o - U <br /> D | Field: Distance from | from <br /> � <br /> ---- <br /> Number of | ' -Lengtho <br /> Type of filter mo+erios �� - �� ��-DnpH, of �|+=, m° length--------- ' <br /> ------ <br /> Seepage <br /> -- <br /> P�� Distance to neonv� w=U�—__-_Didvnce from fuun��H��n_-____-Di��ncetp nearest U, <br /> Number of pit,'''-__-'''Lining material----------------------- Diameter-----------------------Deofh--------------------------------- < <br /> | <br /> Cesspool: Distance from nearest well __.-_Distance from fpunclu+ion- --------------- Lining muh,huL.--'_------ <br /> . [] Size: D4oma+e, Depth Liquid Capacity ��]als <br /> � Privy:- ' -- nce 6nm^ne°rest well-------------------------------------------------Distance from nearest building---------------------------------------- <br /> Distance fonm,m,tlot line. <br /> Remodeling^ and'/or '~p~^^ g r`~~'~, <br /> ------------------------------ ------ ------------------ j��--- ---------------------------------------------------------------------------------- ----------------------------------- -------------------- <br /> I hereby certify fha+ I have prepared this application �nd that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ^ (Plot plan, showing size of lot, Iod;tion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> REY|EWED BY- DATE_ <br /> -V---::rJ-�- <br /> �-'-'lI"-------'�' ----'' '---'--------------------'--------'--'---------'-----'' <br /> u� - - ^_ - .-�_- _-- . .--___-'_'__-__ <br /> '----'—~- -'-'-_'-'-''-''-'''-''-'--. <br /> F|N/\L INSPECTION BY�--. Du+o-----.-"�--.. ---��'^������-_.- <br /> N JOAQU|N LOC/4L HEALTH DISTRICT <br /> /30 s""+k *m°,ic°" y+=°+ 300 West Oak st,°°+ '32 sv"°mo,° Street ow w"*h ^o^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />