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/. <br /> APPLICATION FOR SANITATION PERMIT Permit No, .44-3---4 <br /> ��mp�� � C�p�m�) <br /> ` ' Date Issued .y�3�.� <br /> Application i, kon,6y mo6o to the San Joaquin Local Health District for o permit f" construct and install the work herein 6uso,|6e6 <br /> This application is made | h County Ordinance N � <br /> �1 <br /> (�B ADDRESS /\ �-\ <br /> . K ._0 | ' <br /> (�.ne,, N +��I1l^� `.� '��— Ph�ne��_--_-----.--. <br /> ' 1 � �4 � ~�_ ` <br /> Ad6na�__ 6 / --' ��� �� - '--.'''''--''—_'-------''--'' <br /> Cqntn,ctor', Name_---------------------------------------------------------------------- ---------------------------------------------------------------- Phone—_--'_—'--__.. <br /> |nsta|lation will serve: Residence E] Apartment House D Commercial E'-Trailer Court D Motel D Other E] <br /> Number of <br /> Water Supply: Public system Community system -E] Private D Dept �_, t a b <br /> Character of soil to a depth of 3 feet- Sand D Gravel E] Sandy Loam Clay Loam � ay Ado�e ED] Hardpan <br /> El <br /> Previous Application Made: Yes El"'No n New 'Construction: Yes [:] N o 4r-f t�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Disposal Field: Distance frorh nearest we�l--------------:_Distance from foundation--------------------Distance to nearest lot line----------------- <br /> D Ha <br /> est lot line__ <br /> Distance to neares 'st <br /> Seepage Pit: t well__rd�_�------Distance from jounclation----��___.Distance to nearest - -------- -- <br /> --- :4_� _ -"4, <br /> ------'--'-------------------''--'-------------''--'--------'--''---'--------''-- <br /> '--''--------'---'---------'---------'------------''-----------------'—'------' <br /> | hereby certify that | have prepared this application and that the work will be done in accordance with Sun Joaquin County <br /> ordinances, State la*s, and rules and regulations of the San Joaquin Local Health District. <br /> ---------c*.f..e z--------------------------------_-------------------(Owner and/or Contractor) <br /> By:-------- --------------------------------------------------------------------------------------------------------------------------Title)'_—__�___-------_--'-' <br /> (Plotplan. showing size of lot. location of system in relation to Wells, buildings, etc., can be placed on reverse side). <br /> Z FOR DEPARTMENT USE ONLY '. ' Z <br /> xc,/cv,Eu BY-------------------------------- ��'�—'��--��c�� DATE -~ <br />-�~��U|LBU�8-P2R��IT'|SSULD.��—_-----'-_--���-----.---------------.. DA|�---_---_----.--..,--__.. <br /> /Qtam�ons and/or naowmmnn6a�ons;--------_--.------_-------'-_--.------.--------'---.--------_-- <br /> --_—__—�----_._---_—__—_---.__—._.------._--.__—.—_—.^—.—'____--__-.___--_.-- <br /> �����_�_����__�����'_���_�����___��___���____�__����__����__���'��_��'_�_��'_�����__���_��'__�_���' <br /> —__—_.__----_—.__---_-------._-----_'_—._---_--._--._--_____—_----._._ <br /> -------------- <br /> ----------------------------------- ____�_�� ���--------------------------------------------------��___ <br /> FINAL INSPECTION ------------------------------------------------------- --- Duh:---./—._��--/..--v.-_`°. /- ----------------------- <br /> ' <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> |so sv"m *=°ric°" St,ee* 300 West Oak Street /s Sycamore Street 8/4 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California . <br /> ES-9-2M o'o/ uo./m6 v/-2100 <br />