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.-= <br /> 1 APPLICATION SANITATION PERMIT Pannh N� <br /> \ <br /> ,zplete in <br /> Duplicate)umpxwmr <br /> Date Issued`A Ii �ion­­he—reby m-acle-t L:cca ealth Dist"" mit-to con-struifft and in tall the work-herein described. <br /> ` <br /> Privy:Theis%lcpaplicbtlison is made in compliance with County',OrdinancejNo <br /> 19 <br /> Insfalla-ion-will serve: Residence ' Apartment ouse El I qommercial.,F] Trailer Court (] Motel'E] Ofhe" <br /> units: ------- Number of bed�ooms ----'--- :Number of bat�s­vZ Lot size ------ <br /> �,Iurinber of living units: <br /> Water Supply: Public system Community system 0 Private E] Depfrfo Water Table <br /> Chara r iof soil to a depth of 3 feet: Sand E] ly Loam E] Clay Loam E] Clay E] Adob Hardpan E] <br /> TYPE 6F INSTALLATION AND SPEC(F'IC'-ATIONS: <br /> [(No septic tank or cesspool permitted if public sewe available within 200 feet.) <br /> Septic jTank: arest well-- --- -- -- is�ancq from joujidafjon------ .'IM"Aa <br /> I It No of,comparfmenls---- <br /> fa <br /> Seepage Pit: Dis�ance to nearest f io/dafion__,/-----------Oisf e to nearesf lot line--- <br /> I ppm 14 <br /> Size: Diameter---- <br /> Distance--- from --rest— well'-----------------------''-'� ------------- <br /> Distance from nealrest building''-'''--''--A--'-' ` <br /> F1 Distancefnnnora,+ |uf|F��-��~�-..� ��_-���—'���..__����--����'-����-_����. _�_-'' <br /> Romn6eing and/or repairing (describe):----------- ___.________.�____.__ Y _____._______.__ _____ ^ <br /> ' v <br /> '-------__.-----_--''-__'''_-''-_.'--'-__-''--'__.-_-''__-_-'--_-'------_''----.''-'--'''-_'-' <br /> -----------.------_---------------.-_--..-`----_-.----_--...--------'�_-----_--_-----'- I <br /> ---_--_-_,--_----.. .-__-_-----�_--_-. --___.--___-_.-- ----_'�-__- � <br /> I hereby certify that I have prepared Ws application and that the work will be done in accordance with San Joaquin'County <br /> rules a r ulaftions San Joaquin Local Health District. I <br /> ordinances, State laws, <br /> ------------ <br /> (Plot plan,jhow61ng size of, locat'io of system in relation to wells., I�uildings, efc., can be d"on__reverse sid-e)------------- <br /> FOR DEPARTMENT USE ONLY <br /> ~��p " <br /> Alferaf ions land/or recommendations:,------ <br /> + � , � �� , ' --'''' ' <br /> '-'--_--'----'''---''_''_----'-''''�,-_-,''�-�------------------------------------------------------------------------------ ''-_--- � ---------- <br /> .____________.___________-__-___'�---.--_—..�-.^�----_|__-_- -------------------------L-_. <br /> '--'-'-'''-''''---'--------------,'.'-''—'''------'''-'---'''-----''''--'' --------------------- <br /> ------------------------------­------ <br /> ----------------------- ---------.......... ------ --- <br /> 'i--'--.--'--'---''''''----''-' _''''- '--''-'''- '�`�`'-'''-- -''''''--'-''-_----�------ -- <br /> -kvx <br /> FINAL INSPECTION BY:-------- - �__ --~� ` --��7� <br /> '--'' <br />` SAN JOAQU|N LOCAL HEALTH DISTRICT ' <br /> 130 South American er;ef »oo Wes+ Oak Street ' /32 Sycamore Street m* North "C" Street . ^ <br /> a""uo". California Lodi, California ` ^ , w°"f"".`c*xfom|" T="» California � <br /> ES-9-2M x°.a°a vv-2/00 <br />