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� <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit— No. <br /> 'u <br /> � <br /> (Complete in DuplicateDota' ssund`, <br /> cJ hereby made to the San Joaquin Local Hoo|+h District for o permit toconstruct and install the work herein described. <br /> This |i fi is madein | with County ` <br /> ---------------------'—' <br /> -------------------------------------------- <br /> Installation will serve: Residence B---A--partment House [] Commercial I-] Trailer Court [] Motel 0 Other [-] <br /> Water Supply: Public system 2--1-&mmunify system F] Private ��Depth to Wafer Table ft. <br /> Character of soil to a depth of feet: Sa <br /> d Gravel [I Sandy Loam F] Clay �mm � Clay E] Adobe ��o E] <br /> sApMade: Yo, �� No � Cunutrucf;on: Yeo [] No Ez--- ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .(No septic tank or cesspool permitted if public sewer is available within 200 feet.)Septic Tpnk;--ro . <br /> Distance from nearest well-----------------Distance from foundation-------------------- <br /> No. of comporhnon�--------..Size--------.--..-�quid 6ppfh------.---Cupa,jh�'_------ <br /> 0|s « Distance from nearest well ------ ---------Di0no, from foundation---------------------Distance to nearest lot line----_-_ <br /> Numbo, of lines-----------------------------------Length of each line------------------------------ offrench----------------------------------- F^ <br /> Tv ' of filter material-------------------------Depth of filter material------ Total length---'-------------. -- <br /> . Snv9nge Pit:� Distance to nearest well----------------------Distance from foundation__ ----- ---Distance to nearest lot line--`._.. <br /> El Number ofpifs ''��—���—Uning material----------------------- Diamet�c'---'�� ----Depth--------------------------------- 0 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining mutorioL---_—_—___._ <br /> El Size: Diameter--------------------------------------Deot '''''---__.'''--''''-----Liouid Cupocify----------------------------gals, <br /> Privy: ' Disfvnoe 6nm neonaaf well-------------------------------------------------Distance from neun,sf building----------------------------------- ~~� <br /> D;stan'cefonearest lot line—---_'—''''—--------------------------- '-''----___________________--_________ -� <br /> RemodnIimg and/or repairing <br />/ —_--'--.—__--,_-----.__--__--__._--___--_- <br /> - ----------------------- -.—_-----_'-__-''—'---- <br /> , <br /> ._-----___..-----__—__.—_--__--.—_---..____-_-_____--__--__._—_---___.—._-_--__.-- <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, Sfafe-4ws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------- --------- -- ----- ------- --------& ---------------I---------- -------------------------------------------------------------(S"um-and/or Contractor) <br /> -------------------------------------------------------------------------- <br /> (Plot �Ian, showing size of lot, location of system in relafion to wells, buildings, efc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y-------------------------------------------- __--__—.. D�TE-�--..x�—,=���'��..�[»*�.__— <br /> REVIEWEDBY-------------------------------------- ----------------------------------------------- —'''--_'''' ------------- DATE'''--_''---'—'''__________ <br /> BU|LD|NG PERMIT ISSUED------------------------------------------------------------------------- --------------------------- DATE--___—_—_'—__--___.. - <br /> AJh:rmtin", and/or recommendations;--.--------------------.-------_------ ---------- ----------------------------------------------- <br /> -------------------------------------------------- --------------------------'--'------''--------------- <br /> '----'------'---'--''--''''--'------'--'''''----'''''------'--''--------''''''—'----'--- <br /> '--_''—'—_-'''' --------------'_—'---'''_''--'''—'''''---__''--',—''--'--'''--''_--'''''—_—'---'_—'' <br /> . ^ ' <br /> -------------------------------- <br /> ------------------------- —'—'-'—''''----_''--'''—'''---'''''''—''''—'''--'''—'--'''''_--------'—'--- <br /> ' <br /> 6' .� —+�xRN/\L |N3PBCT|ON 8Y' ��� ~u Du�. ��. �---'��--�"' —'~`f^----'' ---' ------'� ---------' <br /> SAN JOAQUDN LOCAL HEALTH DISTRICT <br /> |so »*"m American Street 300 West Oak Street wz n'=,rn"r* Street o/* North ^o^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />