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Permit No. <br />APPLICATION FOR SANITATION PERMIT C-4 <br />V, (Complete in Duplicate) <br />This Permit Expires 1 Year from Date Issued <br />Applicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance -with County Ordinance No. 549. <br />JOB ADDRESS AND LOCATION ... Q3_ J6 -------- -------- ------------------------------------------ --- ------------------------------ <br />Contractor's Name__r7le_�___ _ty� )2t �_a - --------- T- - -J - - ----------------------- <br />Installation will serve: Residelc Apartment House Commercial Trail Court 0 Motel El Other El <br />Number of living units: -1---- Nu�nber of bedrooms �Number of baths --- ---- Lot'size <br />Water' Supply: Public system.-k1community system [3 Private [] Depth to Water Table 469 ft. <br />Character of soil to a depth of 3 feet: Sand Gravel [I Sandy Loam 0 Clay Loam [I Clay [],,,Aclobe ff---Hardpan C] <br />Previous Application Made: (If yes,dote ...... ------------- ) Non New Construction Yes No Zr'1FHA/VA: Yes [] No El <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />� �ic ------- -------- <br />Pos fie) - Distance from neareit well-ti-cmi Distance from founclafion_�_Q --------- Distance to nearest lot 7 1;.-- -0-1 ------ <br />Number of linesa;-e-ri - __0L ------- Length of each Iine__q>Z_0 ----.Width of trench ------ <br />Type of filter m ------- Depth of filter maferialmill1r4V ------- <br />Seepape Pit: Distance to nearest well --- �_A.r)��_Disfancejrom foundafion_—_3L1Q ....... Distance to nearest otjine ----_---------- <br />I h 6 tif , that I have prepa this application and that the work will be done i accordance with San Joaquin County <br />ere ' "'r Cle regulations of A San J in Local FWIth District <br />(Signed) &� --- --- nesip§4 Contractorl <br />(Plot plan, showing size of lot, location of system in rel io to wells, 6uiIdings,,__/tc.1__can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />-_--_-_-''-_--_. 0--/ --------------- <br />REVIEWED <br />--- DATE -_-'-'---_-_--'-- <br />�EV|EVYB} 0Y-''-'--'-_.--'''-''-��'--'--'''----�--'--''----''--'' --'-'''-' <br />BO|LD|NG PERMIT ISSUED .__.-_---.--._—.----_--------- ---------------------------- DATE __-_-._---.--.—.----------------- <br />--- K --- ­?�:1_1__::_,__::__­ ----------------- <br />-------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />- <br />1uoSouth American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />