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APPLICATION FOR SANITATION 'PERMIT Permit No. <br /> --- <br /> (Complete8n Duplicate) <br /> Date Issued <br /> go|�ot�n ishere6v/nudo to the Son Joaquin Local Hom|H` District for u ponni} constructhzand in�aUdescribdescribed.+ho~o,� herein described. <br /> application6in'compliance with County rdinance No. 549. <br /> --' <br /> ------------------------------------ <br /> Installationwill Residence M Apartment House 0 Co Trailer Court Motel <br /> -- _ <br /> n s Number of bedrooms 4" Number of,�baths <br /> Water Supply: Public system El Community system E] Private [@'-Depth to Waf4r T60&-/_A­ff`.-`_ <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sanrcly-locim 4 Clay Loam Ej Clay Ej Adobe[] Hardpan E] <br /> TYPE OF'INSTALLATION. AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer i�'availa6ler-lwithin 200 f66+.) <br /> Distance fr?m f9andalion Material- 42- <br /> Septic Tan C)i stance from nearest well-- -- ------�__ <br /> Size <br /> Disposa <br /> Distance from nearest well-L.42--hisfance fr'orn fou.ndafioR Distance to nearest lot line-- <br /> 4.1 <br /> ' Coa,poo|��+~ Distance from nearest well-----------------Distance from foundafidn___J--------------L <br /> --- -� <br /> Liquid-----~.'_ ' - <br /> P�vy� D �o �� wcU-_ -- -�i�=nc�_ from nearest 6ui/6ing----------------------------------------- <br /> ' ^k <br /> F-1 Di nearest 1of'U -----------------------------------------------------------------------------_.---______._._. <br /> Remode/ng ` <br /> ^ <br /> and/or n*p�i � (6e���u ��-__'-�-''---_-_---_---__.-'''---_�__-'''_-''---__-�'__.________ <br /> ` <br /> ��`��'----------------`----------```--------------------���������-------������-----�''��----�� ��������'�����'�'����- <br /> -------------------------------------- ---_-''' '----''_-______--.___''-__----____-_---.----. <br /> ip <br /> - -- -'- ---'---' <br /> I hereby certify that I have prepared fhi! application 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 Local Health District. <br /> � (S ---._-----._-------.-. and/or Contractor) <br /> ~,--'--'--'-----------'-----'---'---------------v^=)---------------------------------------'--- <br /> (Plotplan, showing size of [of, location of system in relaflon to wells, 6uildings. etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY - <br /> / =- - --- <br /> .APPLICATION ACCEPTED --- _ <br /> REVIEWED 8Y-- � <br /> --------------------------------------------- ---.----_------- D <br /> DU|LD|NG PERMIT ISSUED-----------------------------------------------------------------------------------------------------T?(T[-------_--_--_'_-__-____ <br /> AKorutionx and/or recommendations:---------------------------- ------- ------ ---------- <br /> -------------------------- ----------------------- ------ -------------------------------------------------------------- --------- -------''''-''''---'----''-_------------------------------ ------ <br /> '-------'-'--'---------------'-'--'----------'----------'------'----------'' <br /> ---------------------------------- _________________---_____________�______________________�_ <br /> ' <br /> '-''---'''''-''-- -'--'--' <br /> F|N/\L INSPECTION BY------���-..�'!-_--�--_---_- Duto----.--1.-�!��\��'����. <br /> ^� <br /> ' <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> ' /nn South American Street 300 West Oak Street /zx Sycamore Street , ow North "C' m=° <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> � <br /> ES-9-2M /0-52 Revised vv-2/00 _. , <br />