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APPLICATION FOR SANITATION PERMIT 64 <br /> (Complete in Duplicate) <br /> T�plicat on is hereby made to the San Joaquin Local Health Dist ricf for a permit to copsTrFuct �nd install the 0 k herein�Iescribed. <br /> is application is made in compliance with Cou y Or&nance No. 549. <br /> JOB ADDRESS A)D CATIO ..... . -�_ /�_ �_ _ -------- <br /> 01 <br /> Installation will serve: Residence [�V_ Apartment House E] Ccmmercial A Trailer Court E] Motel -E] Other El <br /> Wafer Supply: Public.system E] Community system El Privafex , <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] <br /> Loam El <br /> El <br /> . , Hardpan_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within <br /> Supf|cTanL: Distance from nearest well-----V/----�Distance from �on-----------� e-' Moferim <br /> No. ofcompartnoanfs-----? ----Cupucity-' -_..Sizo .. - '^�------Liquid dep+h..4r2--------------- <br /> Cesspool: <br /> ---- _-_Casspoo|: Distance from nearest well-----------------Distance from foundation------------------- Lining nnufur|uL----------------- <br /> [-1 Size: Diameter-------- -_-----__-..--__---- . <br /> ,'Privy from ` <br /> / -- Distance to nearest lot line------------------------------------------------- <br /> Seep <br /> '-- -_''.'-_ <br /> -- . .. Distance .. nearest" we ---ll^ �~-~~'� ~...~.^~ <br /> -Disposal Field- Distance from nearest well----117�-----Distance from.foundation-----2-60-----Distance to nearest lot line__>-�------- <br /> Type cn n/`=r mon,na/-��'-.^���'uepr of n/rv, mntana/--���-_�- <br /> ' < � <br /> -Remodeling and/or repairing (describe):---'''_'-- ----------------------------------------------------------------------------------------___._______�____ <br /> - <br /> --------------------------------------------------- -r-----'-- --------------------------------------------------- <br /> ------------------------------------------------- ------- <br /> --------------------------------------------------------- ----------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> __. � <br /> I hereby certify that I have preparedfh& " <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> 4-St----------- <br /> (Plot plans, showing size of lot, location ofsystem in relation tnwells,' buildings, etc., must be filed with this <br /> ' <br /> FOR DEPARTMENT USE ONLY <br /> ' <br /> Alterations and/or ru**mmen6atons:-- - - - - - - - - ----- - - - -- - - - -- - - --- ----- - --- -- - ----- ------- -- - - - ---- -- <br /> 0 ----- -- - - - - - --- - -- - --- -- -- - - - -- - <br /> ------ ------- - - - - - - ---- - - -- --- ---- -- - --- --- ---- - - _ <br /> � <br /> -- - ---- - --- _- _- --.__- -- - - _- ---___--- --__�.��.___-- .� ---- - - . -- --- � - - � ---- . ---- . - - �--- �--. <br /> ` _-` . <br /> - - - -- - -- -- - - --- --- - - ---- - - --- - - - ----- - - -- --- - - ------ - - --- - - - - ----- - ---------- - - - --- - --- - -- --------------- - -- - -- --- <br /> � <br /> -��-��---_''_-''_- ''--.''''--. - - - --- -- - - --- -- - - - ---- - - -- - --- - - -- -- -- --- ---- - -- <br /> �^ ��' � �" <br /> PERMIT No4�-�r-r����. |S�UB]'--''- --� '--(Ju+o) FNAL '|NSPBCT|{}N - ---- - - -- <br /> Dote __--- <br /> ) | SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> [ <br /> 130 South American Street <br /> Stockton, California <br /> a--q-2w9-Smv*1639 <br />