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APPLICATION FOR SANITATION PERMIT - <br /> (Complete in Duplicate) <br /> Application is hereby made to the Sun Joaquin Local Hnn|+k District for o permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance N <br /> 4;9 / - :-,4---t M-A---R?Jea�__7 ----------------------------------------------- <br /> r`du <br /> Installation will serve: Residence Apartmerif House E] Commercial E] Trailer Court El Mofel Other Ej <br /> Community-system El Private :E] 1� <br /> Water Supply: Public system <br /> Character of soil to a depth of 3 feet: Sand E] Gra"vel E] Sandy Loam E] '�-lay Loam E] Clay 0 Adobe -�Harclpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permift6d if public sewer is ii�'ailable within 200 1-feet.) A <br /> Size: Diameter_------------------------------------Dept h---------------------------------------------------- N <br /> ------------- <br /> � ^== � . ... ~.....^. .. ....'. '_ Distance -_~ <br /> _-_ -' nce to nearest- _ ------ <br /> ---- <br /> ��Num6o� . - - i � � <br /> .� _- . ~Disposal ui � <br /> Number of lines <br /> ----------Type of filter "."=`"._, D"p,. of filter, material----------+°------- <br /> . <br /> Remodeling~dn6/or repairing [cln`xri6o ' <br /> ' .-_._-��°___--___...__..___-..�f~&�J��Z�{-�l����/__�°J���������&���^-_____-__..---.-.__.___.�_- <br /> ------------------- --------T-----''---''----''--'-----''---'-----''----------''-'--'--'-----''— ` <br /> / . � / <br /> / � -__� ' ------' <br /> I herery certify that I have Orepared Ais application a�d that the work will be done in accordance with San Joaquin County <br /> ordinances, SfMajaws, and rt,-J�nregulafions of the San Joaquin Local Health District.�-' <br /> loi- <br /> in relafl��to wells, louildings, etc., must 66-file' wifh,this applicatio6). <br /> (Plot plans, showilrg size of lot, location of system it <br /> FOR DEPARTMENT USE ONLN��% <br /> DATE_ACCEPTED 8Y_� r .___-----_------� � r <br /> ---_'_ <br /> REVIEWED BY.-__-__--_-_-'_`..-.__� - --------------------.__�D/� � ---.--_--..------_-------_- <br /> BU|LD|NG . <br /> PBl��|T |��UED...__._____�.--,---____._'_-._--___�--- DATE <br /> and/or ,wcommwnclwfions:------------- .--- ---------------------------------------------------' ------___---------------------------------- ----------------------- <br /> ----------- -_-----.--_-.-----_---_-_---_------.---_---_---------'` ----------- ----------- ------ ------------- <br /> --------------------------------------------------------------------------------------------------------------------------------- ------------'.__-...---'--___--''__------- <br /> ---------�---''---'--'--''-------------------'-----'-'--------------------'-----'-----------'- <br /> i --'`--------''-----------' ---------------------------'-- ' ----------------------------------- <br /> PERM <br /> --'-- <br /> PERM|T --------------- FIN/\L INSPECTION ��I. <br /> ` Dot"------.. --- <br /> SAN <br /> / <br /> ^ SANJOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> . <br /> Stockton. California <br /> ' ss-^+-2w 9� m <br /> ow� 3v <br /> ' <br /> _ <br />