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' <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> �ump�� � C�u�m�l <br /> ` ' Duplicate) <br /> Date |soued5---±. <br /> \ � <br /> Applica+ionhereby mo6a +o the Sun Joaquin Local Health District it construct and �atu||+�e*�,� ho�� �o���6o�-b <br /> This application is J o| ^~-- — <br /> ------------ <br /> Installation will serve: 'Residence F] Apartment House E] Commercial ��er Court El Mofel Other E] <br /> Number of living units, .------- Number of bedrooms -------- Number of baths -------- Lot size AV <br /> Water Supply: Public system X C-ommunity system 0 Private E] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam E] Clay Loam E] Clay 0 Acobek Hardpan <br /> Previous Application Made: Yes Ej Ndo---N—ew Construction: Yes F1 No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> osal%F Distance from nearest well-----------------Distance from foundation------------------.-Distance to nearest lot line-------------_-- <br /> k or <br /> Co=pnoL Distance from neon,d well-----------------Distance from foundation--------------------Lining material-------------------------- <br /> S�ze: Diameter Doo+ Liquid Capacity- gals, - <br /> I hereby Trti ry a, I la prepared this application and that the work will be done in accordance with San Joaquin County <br /> "es. Stfl <br /> ordinai ws and ru es an gulatio of the San Joaquin Local Health District. <br /> b ( - _ __81------------ ------ <br /> (Plot plan, showing size of lot, location of system in re fion to wells, build" gs, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DAT ------ <br /> Alterationsand/or recommendations--------------------------------- ----------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------_--------------------------------------------------------------------'-------------'------'------------------'----------- <br /> ________________________________________________________�____________________________________' <br /> ._--_—_._-----_---_-----_--.—_--_---_—._.—_------_--____--_--'--__.-- <br /> '---'—''--''--'''--'''—''--''' —' '--'''—'''—''''—'---'--'''—''''' ------------------------------- -- <br /> FIN/\L INSPECTION BY;---------.—_---__----. Date---—---------- ---_---..'- -_----�___. <br /> SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> /mm s""m American Street 300 West Oak Street /»s Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> cs-9-2m . I xov."vdvv-2/oo / <br /> , / <br />