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. . APPLICATION FOR SANITATION PERMIT Permit No. . - <br /> ^ <br /> Um Duplicate) L111`~~^r~'~ -/ Date |,mue6 _'�������� <br /> ' ^ ~^ <br /> yordinances, S I rigulations of the San Joaquin Local Health District. <br /> Yiate aws, r es and "I <br /> �7 <br /> uin Local Health District for a�permit to construct and install the work herein described. <br /> A-S-S A N L --- - --- --- -- - -- - --------- <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court 0 Motel [-] Other <br /> Number of living units: Number of bedroomsv*,�O . Number of baths _/---- Lot size - - -----zzee_ _�-------------------- <br /> Water Supply: Public system- El Community system E] Private IV Depth to Water Table17 <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam Clay Loam E] Clay E] Adobe E] Hardpan F] <br /> Previous Application Made; Yes E] N XO New Construction: YeX�o 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> jNo septic tank or cesspool permitted if public sewer is a�aila6le within 200 feet.�'-7 <br /> Septic Tank: Distance from nearest well-- A5_0-----DistancCfrom uridafion!' 4 <br /> No. of compartments-.119—---------- iquid dep�h__ka_ <br /> D91 Field: Distance from nearest weJ//1.Z­­�­­­­­­­­----Distance from foun/dation__��_�_:,_I------Distance to nearest lot line----- .!�------- <br /> Number oi lines---- --Lengtn of each line <br /> Distance from. <br /> I hereby certify that I-have prepared this appl-Ication and that the work will be done in accordance with San Joaquin County <br />- <br /> (Signed) - -------- (Owner and/qr Contractor) <br />---~- ~ ��,{x �o (*t;�� |� 6�|Ji - 6e�5���� n- xe/��e) <br /> ------------ <br /> BUILDINGFOR DEPARTMENT USE ONLY <br /> PERMITISSUED---------------- -----'/�----_-----_------------. DATE---------_--------_---- ~ <br /> A|term�ono and/or ,ocpmm*nda+�^u:----�------------_.-------.---.--�--_-------_------__---___. <br /> ---`-'-------------------------`----------------'--'----------''--'-- <br /> '--'-'--'''----------'-''-'''-'''-'''---''--''-''--'--'-''-'---'''-''----''--''----'--''-'--'' <br /> ---'--'--'--'-'''----''''''-''--''—'''''''-'-'''--'-----''-'''-''''-''''--'''''-''--'-----'--- <br /> '_---''-'-_'�-�-''- ''_--'''-�- '--'-'''' _-''--''- <br /> -- <br /> ~ � �� �r�-- ~ <br /> F|N/\L |N3PECT|{}N BY�--��r���-.~�-�...�~ D*+u_-_-..��--�-----..���/-��-----.--- <br /> . - ' <br /> - SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> - /xo sv.fh American str°ot 300 West Oak Street. /m Sycamore Street u|* North ^o^ $tre° <br /> St""uo". c°xa°rnia L.1i o°||f="i° Manteca, California Tmm/. California <br /> `� / es-9-2wRevised v/-2/00 <br />