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� <br /> APPLICATION FOR SANITATION Porm� Nu. ���''rx.K <br /> (Complete in "°p"°"'=, Date |s�*6 -F/Ip <br /> ° <br /> Upplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described <br /> This application .^ made "' °""pa^~~ with County Ordinance-- No. <br /> ------------ <br /> Contractor's Name_-----------------V--------------------------- Other E] <br /> Installation will serve: Residence-2"'Apartment House-0 Commercial 0 Trailer Court El Motel <br /> Number of living units: A---- Number of bedrooms -:4- Number of baths ---/---- Lot size ------------------ <br /> Wafer Supply: Public system 20--community system El Private 0 Depth to Water Table ft./ <br /> Character of soil to a depth of 3 f6ef: Sand [] Gravel E] 'r Sandy Loom D Clay Loam Clay [I Aclobe gj"lHardpan El <br /> Previous Application Made- Yes [I No U?"-'New Construction: Yes E]. No 2--__ <br /> TYPE. OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer <br /> ! Tank: Distance from nearest wuU ._--.-Di�uno: from foundot��.-_-_-Kxatnrmo.-'-'-''''�-'''-'-_'' <br /> . Septic- ���odfy' <br /> [� <br /> No. c� �mnn,� "."= Liquid depth <br /> � ----aU---I----Distance to nearest lot-lin - PTO_ <br /> � O Field: Dist | na� u/mo""e .,"". foundation <br /> . Number�� - «Type of filter material-MA_/&6�� r ` Total length - <br /> �/l <br /> ' <br /> � n�^ " . �2{� <br /> -_ nearest_ _ <br /> .oj ,6�epoge. H+: u/�anoo to neana� wax-..==- "`^.""ce . <br /> Number of pits--------- Lining mate Size: U|umo+ec..2��3...........�Depfh-'1-0--- <br /> ----.. <br /> Cesspno|- <br /> Distance from nooro, well .----'-Distance from foundation--------------------Lining mn+e,uL--'-'�-''---'_� <br /> ' [] S�zv: Diameter-------------------------------------- _��-'_-�-_-..�.. i6 Capacity-.-------------------------- 1 <br /> _= � .-� _ <br /> �~ -� 's D|�unoe Iro' n6aroo ' U----------------Distunce from nearest building--------------------------------------- <br /> - <br /> -Distance +o r�� �� |� ___�____ <br /> ' nearest e------�'`,—'''--''--'--'--'''---�_----''-''-'''- <br /> . R6mode|iog and/or repairing (docr6o):----------_--_.__-_-._-_-.__-.--_---___.___.___- - - - <br /> ._.--.__-_.__._�_.�------__-__--__- --- -- ---- -_-____'''-__-'_--'' --- -'''-'_-'------'-'-''-. � <br /> ---- - - --- ---- - ------ - - - - -- - -- ------ - -- . .. --- -- --- - - --- -- --- -- - - - - - - - - - -- � <br /> ��-.---------''---'----'--^-`---'--------''--''-'''---'---'''-'''--'-'''- ' | <br /> '----------'---t.I have prepared f his application d thathe work will be done in accordance with San Joaquin Cnun+y | <br /> ordinances, State laws, and iles and regulations of the San Joaquin Local Health District. <br /> \_� / <br /> ��n�� � <br /> (Plot p Ian, showing size of lot, location of system in relation to wells, buildings. etc., can be placed on reverse side). <br /> FOR DEPARTMENT ~~~ ~^^' <br /> LIN <br /> ` REV|E\mED BY-_---'-------z�-/- -------------- ------------------------ -------------------------------------... DATE------ <br /> BU|LD|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------- ,". -------- ----------------------------------------------- <br /> Alterations <br /> _________________.__Alte,ations and/or recommendations:----------------------------------------- ------------------------------------------------------------.------------------------------------ ------------------- <br /> ! -L--_------'-------------------------------'---------'----'---'--'-----' <br /> r ' <br /> �/ �___`________'-''__-''--'''--''''''---''''---''''---''---'--, ''--'-''''-''--''-'-''''--''--'---' <br /> . ''---'''--'''--'-''_''-'-''''----'-''-'''''-''------ <br /> - ---^--''_'''-''''---'-''''---''-_''-'��--' <br /> | '-''-'--'-''''' --------------------------'''''-''''-'''�-'-'''-'''---'''' -------------------------------------------- ------------------------------------- <br /> -' <br /> . ^ � �l ~~� <br /> FINAL |NSPECT|[)N`BY�---��1� »���-..�----�-.--�-' Date---/���-�_�y��.-------------- -------------------- <br /> ` SAN JOAQU<N LOCAL HEALTH DISTRICT <br /> /»oSouthAmerican��", °" Street woWest o° Street 132 Sycamore Street 814 North "r' Street <br /> mo=H*n. 00{ifo,"iv Lodi, California Manteca, California Tracy, California <br /> ES-9-2M /0-52 n^va^d vva|oo <br />