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APPLICATION FOR SANITATION PERMIT Permit No. <br /> [Complete mDuplicate) <br /> Date Issued -_..'r��� | <br /> App|ication1i hereby made to the San Joaquin Local Health District for,a permit to construct nd install the work herein described, <br /> NumberThis application is made in compliance with County'Ordinance No. 5 <br /> -,--? 7- ---------------------------------------- Phone--./e- -. <br /> Installation will serve: Residence Apartm'enf-Hou Commercial [] Trailer Court E] Motel El Other El <br /> _ of living. units: Number of baths _/- Lot size <br /> Water <br /> Supply: +e Depth +oWater To6| <br /> ft- <br /> Character of sox to m depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Ad Hardpan E] \ <br /> Previous Application k4m6e: Yes [] No," Construction: Y No E] <br /> � TYPE OF INSTALLATION AND SPECrP|r!Xr|{}NS: <br /> (No septic tank or ceoqono| pv,6`iffo6 if ptib|icswwor isavailable within 200 feet.-) <br /> STa k Distance from neorestwaU--.----Distance from foundation--------------------Material <br /> -----.---.-------- <br /> No. nfcompo,hnohts--------------------------Size-------------------- ----------Liquid depth------ --------------------Capacity---_------------------- -- <br /> .Disposal 21elpdwDistance from nearest well-----------------Distance from foundation--------------------Distance to nearest <br /> �t |ino--- <br /> ------ <br /> Number of ||n*�._-- -------------------- Lengthof each |�`�'---'''-''--V6fh of +�nc6-_--__--_ <br /> Typo of Filter mo+o�o _-�_�-'-_.Depth of fiiter material Iuta| length <br /> .�� <br /> S Pit: Distance to nearest weIL__-21__,4-------Distance �6m-fou afion--- .......Disfpnce to nearest lot line------ <br /> Cnspoo� Distance from nearest well _--'-_Distance from foundation------ ''-Liningmaterial --__- <br /> [] <br /> Size: Diametnc----__------Dep+ -_--.------_--.--'- -_Uoui6 �uput ---'-------gals. <br /> Privy: Distance from nearest well------------------------------------ -------------Distance from nearest building----------------~.__--__.__- <br /> [] Distance +onearest lot |lno- <br /> -------------------------------------- <br /> Remodeling and/or'repairing (describe) <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, State laws, ' rules a r Igulations o San Joaquin Local Health District. <br /> (Sign <br /> | �~� ' ----- / <br /> ' . - � ,--� - �-'- - wells, -~^~^^w~ ^'~" can ~~ o' reverse " | <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION-ACCEPTED DY----------------- ------------------------------------------- -------------------------- DATE----------------- <br /> REVIEWED BY'.-_-_._----------'-'---''-''-'^'``~''''�--'''--' '� --~---''' <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------'''-�''''--, '- DATE <br /> Stockton, <br /> DATE�---_.� <br /> A�vm�onx and/or recommendations <br /> ------------------------------------------------------------------- r <br /> , � ---------------------------------------------------------------��'''--'-'-'''_-_-_-'-------------------------------------------- <br /> SAN <br /> .--_-''--_---�-'_-'_-' <br /> '--'- <br /> - <br /> --�------ <br /> '-'-_'--_'-''�_''--'�-''-''�--''''---'--�'''-''''----��'--'''----''-_-'---'- '''----.--'---'__ <br /> -'------------------------�------'--------------- --------- '---'------- <br /> --'-�-'-_.-'-_'��''-''- -''.�'-''''_- �-'-'''-' ''���'''-'-''--'''�--'-.''-'-��-'---''--�'-''_ <br /> RNAL INSPECTION BY; '' -''`-. Date-------------- '________ <br /> SAN JOAQV|N LOCALHEALTH DISTRICT <br /> 130 Street amov �+ Oak s�°° /xo Sycamore ��° ow w"*h "C" Street <br /> sm"��. o��"�� Lodi, California wa"�" . California Tracy, California <br /> � <br /> ES-9-2y 8-5/ n".u"a v/-2/00 <br />_ <br />