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' S-1 <br /> _ <br /> - f ) / <br /> 9�� <br /> APPLICATION FOR SANITATION PERMIT <br /> No. -_��.��_�' <br /> ~�- VComplete in /�. <br /> V D-'li��-' Date | 6 <br /> � <br /> madetothe San J � Local Health D���f� o permit to construct andinstallt�`�� herein described. <br /> |hisapplication is made in pliawith County D"d| <br /> nance N10. 549, <br /> .~.". ^ ."=.=--------N. <br /> ~= <br /> Installation will serve: Residence Er--A-partment House E] Commercial El Trailer Court E] Motel E] Other E] <br /> Water Supply: Public system Ep�clmmunity system F1 private F h---- I <br /> Depth to Water Table ------ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy toam E] Clay Loam Ej Clay E] Adobe R-11aldpan I-] <br /> Previous Application Made: Yes E-] No ��Nlw Construction: Yes E] No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> fepti (N o septic fta k or cesspool permitted if public sewer is available within 200 feet.) <br /> Ta D <br /> c <br /> ��;/- - \ '`". of c""'pa""'""'^-----_-.uue--------------------------------Liquid dop7n -------- --------------Capacity----------------- <br /> Distance fnzm nvunosf well --''-Distance from foundation--------------------Distance fonearest lot line'---''' <br /> Numbe, of lines--------------------- ------------- of each line--------------- --------------Width of french'_-._-_--_' <br /> T,oe ofVte | <br /> � mf <br /> th <br /> , <br /> S �: Distance �| P , <br /> Number � p - ..Lining m W �.- ~~ <br /> ---------- <br /> Cesspool: Di�mn+n,�.��`�r.^�-�o�t�������"��'- ' <br /> Distance from neurudwull-----------------Distance from foundation------------------ m«+*ruL'''''-'---'-''�_ <br /> E-1 Size. Diameter ..---------------------------------Depth ---' -------------------------------------Liquid Capacity-'---.----gu|s. <br /> Privy- Distance from nearest xo|L----- --------------- ----------------------Distance from nearest building--------------------------------------- <br /> Distance to <br /> .--Distonceto nearest lot line-'''--''''-''''-'--- -'''-'''_-_---'-_--'-_ ___�___________ " <br /> Rnmo6e|ing and/or repairing (describe):-'--'--'-''---'-_''''-----__-'''__-___'-''-'''_____.____________ <br /> '- <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, Sta-fe laws, and ru ns of the San Joaquin Local He I h District. <br /> ,~' plan, showing^ ~^~ of ~' location of system in relation ' ' <br /> FOR DEPARTMENT USE ONLY � <br /> REVIEWEDBY--------------------------------- --------------\� ------- ------------------------------------------------------ DATE----- ---- --------- <br /> ----------------I------------------ -T------------------ ---------------------------------------------------------- --------------------------------------------------------------------------------------------- <br /> ----------------------- ------ ------'-------'--'-------'------'--------'—' | <br /> F|N/\L INSPECTION BY:, ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH <br /> --------SANJOAQU|N0CALHEALTH DISTRICT . <br /> mu S=+6 American str°°* aooWest Oak Street oz Sy="m",° Street ow North "C" Street <br /> sm"uo". California Lod|. California Manteca, California nw~» California <br />