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APPLICATION FOR SANITATION PERMIT Permit No. .....4----------- <br /> (Complete in Duplicate) "Ij Date Issued --- <br /> T�plica+ion is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> is application is made in compliance with County Ordinance No. 541?, F44LO.-f-. <br /> Installation will serve: Residence UKApartment House El Commercial E] Trailer Court [] Motel E] Other E] / <br /> Wafer Supply: Public system El Community system F1 Private 2-bepth to Wafer Table Ju_ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [j?-'Clay Loam El Clay E] Adobe E] Hardpan Ej--- <br /> Previou Made- Yes [] No [-] New Construction: Yes El No ^( <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> / <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se nk: Distance from nearest well v- Distance from + do 1ux . <br /> L� mv mo/mpom�n� V ^ =_�y"'" =p " '� w =p�'�_ \ <br /> 16314 <br /> Di, a|d: Distance from U -40. ce from foundafion—/0-.. Distance to nearest lot line-----------Q..' <br /> Ey" Number oflines � �ng� � eo� V�� � +�n� " <br /> Tvuo of filter mat � � <br /> ma~~ ' <br /> Distance to near�est Seo �� to neo�sflot line`..Q—..- <br /> meNumbnrofp�o �--.—/ -Uning mu+a6u ._- �e: —Depth—'���.------------------ <br /> Cesspool: nearest <br /> Distance fnzm n�u�� wo|�''��--D�f ncnfn,mf�un6ut�n----__Un�g m�+�,�L------''--�_ ' <br /> E] Size- Diameter'—''--'-----Dep+h—'''_''--'--'---'—Uouid Capacity---------------------------- <br /> Privy: Distance from nearest well------ ------------------------------------------Distance from nearest building--_----__---- <br /> El Distance fnnearest lot line........ '—'''�--�� - ---------------------------------- --'—'__—'—''—'''—�—''_''--- <br /> Renoo6elingand/or repairing (6eszribe)------------------------ -----------------------------------------------------------------------------------------------------------—. ------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------- <br /> '--''---'— —''--' '--'--'''--''—'---'--' --'' - --' | <br /> _____js <br /> I hereb cer fy fh I hjav this application and that the work will be done in accordance with San Joaquin County <br /> P prepar <br /> ordinances, lai ule and r ulafions of ffhe,0,SSan Jjoa ujn Local Health Disfricf. <br /> (Plot plan. showing size of lot, location of system in re i to wells, buil ngs, etc., can be pI ed on reverse side). <br /> FOfe DEPARTMENT USE ONLY - <br /> BU|LD|NGPERM|T |SSUED.----_---_--._----_-----_—_-----. DATE--_—__-----.—_—__.— <br /> Alterutionuun6/orrocommon6a+inns-------------------------- ---- ------ --------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------- ------------- -------------------------------------------------------------------------------------------------------------------------- <br /> ----------`—`—`----````—```--``—`````--```````--`—````--`--``—```—````—``--`--'`--```-`—``------`-- <br /> --'--'—'—''--'—'--''--'''—'''----'---'--'''--''—'''—'--'''--''—''—'----'----'—'--'-- <br /> --'''—'''''''''--'—'''--'-'—''—''--'''--''—'---'--'''—'''—''''—''''—'—'—''--'---'—''----- <br /> RNAL INSPECTION BY:----' --------.—.. Do*�-----..��--��—�--�c-------___ <br /> SANJOAQViNLOCAL HEALTH DISTRICT <br /> /nn s""tk Americ-a" $tr°.* uum we* Oak s*°°* /sz Sycamore Street u/* Mv+h 't:' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ""_,_"m `=°^^`°""" .`-= <br />