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\\^ 'Q, � APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Comp/eh, in Duplicate) � f�� <br /> - Dn+n Issued ��'�_<.��-'.a+-^ <br /> App|iocifion i, hereby made to the Son Joaquin Local Health Dis+rict for o permit to construct and install the work herein described. <br /> This application is moJn in compliance with County Ordinance No. 549. <br /> --- ADDRESS ' ^ ' <br /> ----------- <br /> Installation will serve: Residence E] Apartment House 0 Commercial N Trailer Court E] Motel 0 Other E] <br /> Number of living units: ____44umber of bedrooms ------- Number of baths Lot size -- <br /> Wafer Supply: Public system �4 Community system E] Private [] Depth to Wafer Table 3-5�_ft. <br /> Character of soil to a depth of ] feet: Sand E] Gravel [] Sandy Loam 0 Clay Loom EJ Clay El A6o6vP� Hardpan [� <br /> Previous Application Made: Yes 0 N F� M�* Construction: Yes [� No ' ` <br /> . _ r\ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted ifpublic sewer i, available within 200 feet.) <br /> plic k, Distance from nearest well-----------------Distance from foundation--------------------Material _--------------- <br /> No. of compartments Size-----------�qui6 depth—_------Cupoc�y—_--_--. — <br /> D��,�| ���� <br /> Distance from nearest woU+&t/iC- D��o 6n foundation ~��� ' D ' �~r <br /> ' -- — — '^'~'^~ '~ ^�~'~"' v <br /> Number of linesLength of each <br /> ---------- <br /> Type of filter mu+�rio|l�� -����^-Dep+ of filter mofe,iuL./�Z"--------Total length---------ZO ~....................... <br /> _— <br /> Seepage Pit: Distance to nearest wo| Arl�� Distance from foundation---/0 ' Distance to nearest lot |i <br /> Distance to nearest lot line------- <br /> Remodeling and/or repairing (describe ------ L'L-C.. ........ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, Sf laws, and, rules and re,gula rtions of the San Joaquin Lo-ral Health District. �y <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---j---------------------------- --------------------------------------- -------- - ­.- DATEb> <br /> c_^ <br /> BUILDING ER <br /> A�om6on, un6/or ,eoommon6af�no�_—______—._.--_.-'----'--------_--_.---_-------- ------------------------------------------- <br /> -------------------------------------------- ------------------------------------------------------------- <br /> ---`--'-----------------`------------'-----'--`-----`-------- <br /> ----------------'-------'---'-------'--------------- <br /> � ��� ---------------- -- --------------------������''����.�'.�����'� ---����'������------- <br /> F|N/\L INSPECTION 8Y '�/���" �'����'— Do+e—. - - - -- - ------ - -- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> /m s""m American Street 3ooWest Oak Street /32 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-5/ n°./""a w-2/00 <br />