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. � <br /> APPLICATION FOR SANITATION PERMIT Pe,���No _',,------ <br /> (Complete in Duplicate) r <br /> Ili,If <br /> A Irlication is hereby made fo..the San Joaquin Local Health Distric�ior a permit to construct an stall th��cR erein described. <br /> This application is made in compliance with County Ordina 0. 54�9 ®r <br /> JOB ADDRESS-AND' CATIO <br /> ' <br /> ` O^"n mo <br /> Installation will serve: Residence 52V Apa rf ment House [] -Commercial El Trailer Court E] Motel Ll Other E] <br /> Number of living units: _/---- Number of bedrooms-t-- Number of baths _/--- Lot size --------- <br /> Water Supply: Public sysfemx Community system [] Private E] Depth to Water Tableo4��ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam El Clay Loam E] Clay E] Aclob_<Hardpan E] <br /> Previous Application Made- YeaW No& New Construction: Yes El N <br /> TYPE OF INSTALLATION AND SPECIFI&TIONS: <br /> (No septic tank or cesspool �o,mnHfw6 if_pu6liusewer isavailable within 200foe+] ' <br /> Sopfic Tu?k: , Distance from nearest- Distance from foun��+i�n--,- —k4mtorioL-------_-- <br /> �,.p] No. o[ conpportnenf�_—_—_--�S�°—__-_--_—._�quid depth--------------------------CupucHY_- ---'-- <br /> r / ' Distance-- from '--r--' well ~'^'°'-" from foundation--------------------uon,ncu no <br /> Seepage 'Pit; D;stance to nearest well,,. �----Distance frZm fp,4dation--- D�jsta e to nearest lot-line <br /> Number of pits---- Lining materia -Size: Diamefe-'_Z-'11!;1 ----------- <br /> Privy: Distance from from nearest building-- <br /> -_ �`—n-em—na /o-r�/ <br /> j Number pt U <br /> --------------- <br /> RemoAing and/or r pairing (describe).,------- <br /> .�`,__ __'—___--___-_—..__._--_—___---- <br /> ---' '---'-----'---___.—_____- _----'------------_—..—.'-_______—_---.'. <br /> �� ~ <br /> ------------------------------------------------------------------------------------------------------- <br /> ------ <br /> ------------.----------------------------------------------------------- <br />> / hereby Icerfif, that I have prepared this application and thbf fher�York will be done in accordance with San Joaquin County <br /> ordinances, Sta a and le's an&regulafions of the San Joaquin Local Health District.� <br />` (Signed)__. <br /> (Plot plan, showing size of lot, cation of sysfem in relation to wells, buildings,-etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By_ <br /> �4�--------------- ------------------------------------------------------------------ DATE- <br /> -------------------------------- <br /> Alterations and/or recom dations* <br /> ------------------------------- <br /> SAN-JOAQUIN LOCAL HEALTH DISTRICT <br /> /so n""m American Street. amWest Oak Street /ao Sycamore Streem* m=fh 'C,' Street <br /> � <br /> s"cuo". c°/n","r" Lodi, California Manteca, California Tracy, California | <br /> es-9--2w v's/ a",/sea vv-2/00 <br />