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.~. ~. . .~^ USE. <br /> / <br /> V � APPLICATION FOR SANITATION PERMIT Permit No _-�101L � <br /> l (Complete in Duplicate) <br /> Date Issued <br /> ^ <br /> Appl <br /> bu+k'n made huthe San Joaquin Local Hm6KhDist Hctfor upermit tuconstruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No.'549.JOB ADDRESS AND LOCATION -;---3------- <br /> ^ � <br /> �� N 1. ^ <br /> Installation will serve: Residence ��Aparfment House E] Commercial [':] Trailer Court Motel [:] Other <br /> Water Supply: Public system Coi.nmunify system El Private [] Depth ro Wafer Table Ar ft. <br /> Chare'.cter of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 0 Clay Loam F -ar pan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Distance from nearest well----1%Ar--.P-Distdnce� from founclafion-10-or---------Material--- ---------- <br /> Disposq�-Relcl- Distance from nearest well-------------Distance Gm fouinclation.19............Distance to nearest lot line---37 <br /> Seepagj�,,Pit: Distance to nearest 11 Distanpcg from foundation-.3 Y.........Distance to nearest lot line--� <br /> ne6 <br /> est <br /> ell <br /> rest <br /> . ' - _ from _`r._ '—_--'�---__------Distance—__ '_� .--_ building--'--_—__.—._— .� <br /> ' [� Distance to nnuny� |c* line-------------------------------------------------------- ----------------- -------''—'—''-- <br /> Remod ' �---_.--'_----___- _-_-- _______.___.___-______.___ <br /> '—'._--_______-__—_--_-��--__.—_.___.__..—'_.--._-;--_--_-_----------_'—_-'—_—_.--. . <br /> —''~---.---'--'—_-------_-----_''---.__._—_-----__—.__—_-----__—____-----_-----.--' . <br /> ---`--'`--`-----------` <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and regulations of he 4,nJoaq in Local Health District. <br /> (Plot plan, showing size of lot, locarlod'o asystem in relation to <br /> can be <br /> laced on reverse <br /> . . ' <br /> FOR DEPARTMENT USE ONLY <br /> ~ <br /> PPLCAT{} ACC .~~l, <br /> -:.-------------------------------------------------------------------------- <br /> e ------------------------------------------------ ........ <br /> | , <br /> .�� ^ <br /> RN/\L INSPECTION 8Y�-..��. -.-..SAN $------------- <br /> Date—' —~-----'—_— / <br /> N LOCAL HEALTH DISTRICT <br /> 130 South American Street ` 300 West Oak Street ' 1o*Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EsnREVISED o'592w542 ^`LA5 <br /> -_ �. <br />