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Permit No.APPLICATION FOR SANITATION PERMIT <br /> -- i <br /> (Complete in Duplicate) Date Issued <br /> Ax lication is hereby made to the San Joaquin Local Healt CDiNoc 5fo�r a permit to construct acrd install the work herein described. <br /> pP <br /> This application is made in compliance with County Or <br /> $ --------------- ---------------- <br /> --------- <br /> M---------------------------- <br /> JOB ADDRESS AND LOCATION -------- Phone--! <br /> Owners Name____________ _ <br /> ------- <br /> ------------------------------------ - <br /> ----------------------------------• _ <br /> Address_.. X133 one -� <br /> Contractor's Name--------------"---- !' Commercial 1-1Trailer Cour} [IMotel ❑ Other E]Installation will serve: Residence El Apartment House ❑ <br /> r 'Number of living units: - "]._- Number of bedrooms ___2-- Number of baths _l_"__ Lot size ---1iL}3�.1.-�j-Q______________._-_ <br /> l <br /> Communit s stem C1 Private ❑ Depth to Water Tabe� ft. <br /> O <br /> Water Supply: Public system y Communitystem <br /> Loam ❑ Clay Loam [❑ Clay ❑ Adobe© Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand F-1Grave4 ❑ y No El ~ <br /> I Previous Application Made: .Yes [I No JD New Construction: Yes [2 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ' [No septic tank or cesspool permitted if public sewer is available within 246 feet.) <br /> I Septic Tank: Distance from nearest well____ pg-Distance from foundation------ tl <br /> ------size �L � Liquid depth--- <br /> El <br /> . ---------Capacity----800---------- <br /> No. of compartments_-___._.---- of each line_____________________________Width of o nearest lot line_"--___--_--__.""� <br /> p ell----------------Length trench----------------------------------- <br /> Dis osal Field: Distance from nearest well________________ Distance from foundation-------------------- t <br /> ❑ Number of lines------------- <br /> Type of filter material-------------------------Depth of filter material-------------------.---Total length__..___"__--------•-=------ <br /> --------- <br /> Distance to nearest well-----_nano-----Distance from foundation-_____.at_.____.Distance to nearest lot line.______�i____._ t <br /> Seepage Pit: - -_ Size: Diameter-------f-_2t---------Depth-----10-------------- ---- <br /> ❑r Number of pits----------------------- materiaL_M� i—QK) <br /> ing <br /> Distance from nearest well Depth <br /> from foundation____----------.___.�muid Ca act ial-----------------------------------gals• <br /> Cesspool: Capacity---­ <br /> I ❑ <br /> Size: Diameter---------------------------- --------Depth q <br /> ---------"- ------------Distance from nearest building______----------------------------------� <br /> Privy: Distance from nearest well--------------------- ------------------•--•----------------_"-- <br /> ❑ Distance to nearest of me___________________"-- <br /> ------------------ <br /> ------------- <br /> tiY _ ---•-------••---- <br /> S Remodeling and/or repairing (describe)---------------�. d �'Sr=�Ct.3.4 s---------- <br /> ----------------------- <br /> -----------------------------------------------------• --------------- <br /> . Thereby certify that I have preparegulations this olf the San and oaqui the <br /> Localwork <br /> Heall heDistr,ct� accordance with San Joaquin County <br /> ordinances, State laws, and rules and <br /> (Owner and/or Contractor) <br /> Si ned D ;L_tta----------------------------------------------- -- - -------- <br /> ( g } � --------- (Title) ( � '.� al-'r <br /> By:--------------------------------------�' x'_;l S -= La <br /> - ---------- - <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> - FOR DEPARTMENT USE ONLY <br /> :. QATE---- ----- <br /> ------------------------------------- <br /> APPLlCA710N ACCEPTED BY_" „__.__ DATE__._ " <br /> REVIEWED BY------------------------ --------------BI�ILDING PERMIT 1SSlfEQ----------------• <br /> -------------------------------- <br /> -------------------------------------------- DATE=------- ,d-V ------------------------------------------- <br /> Alterations and/or recommend ations:----------------------------------------------------------------- <br /> ___"___.___._..___------_-- <br /> --- ------------------------------------------------ <br /> -------------- ----------------------I------------------------- <br /> ----- ---- ---• -- -------------------------------------- <br /> ----------------------------------------------------------------------------------------- <br /> - -- ------ ----.-- ------- ------ --------- ----------- ------------------------------ <br /> - <br /> - <br /> I -------- <br /> FINAL INSPECTION BY-------------- ----_- Date <br /> T/ - / ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT �i <br /> 132 Sycamore Street 814 North "C Stree+ <br /> 130 South 'Arnericen Street 304 Wes} Oak Street Tracy, California <br /> Stockton, California <br /> Lodi, California Manteca, California <br /> ES-9-2M B-51 Revised W-21()0 ' <br />