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"'APPLICATION FOR SANITATION PERMIT Permit NONE ------ <br /> i 4Complete in Duplicate) <br /> Date Issued ---------/ <br /> Ap pion tisheeb� made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------ <br /> Owner's Name--------(A- ....----P------------------ -- ----------------------------------- ------------- Phone----------------------------I-------- <br /> Address................ .........IS---------- ----- .... -­----------------- ---------- <br /> ------- -- ----- <br /> ---------------------------------------------------*--------------------------------- <br /> Contractor's Name----------6,)_A_AJ -- - -----•------------------------ --------------------_---- ------------ Phone------------------------------------ <br /> Installation will serve: .,ns,idence Commercial E] Trailer Court E] Motel I-] Other L) <br /> ,W <br /> , �partment House E] <br /> LD------ <br /> Number of livin4_units: __j----- Number of bedrooms mber of bafhs j---- Lot size .xg--- ------------------------------------ <br /> Water Supply: Public system-;Z"Communify system F] Private E] Depth to Water Table -------- ft <br /> Character of soil to a depth of 3 feet: Sand [j Gravel E] Sandy Loam El ~Clay Loam El Clay t:` Adab Hardpan E] <br /> Previous Application Made: Yes [] No V, New Construction: Ye 0 El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <� <br /> (No septic tank or cesspool permitted if public sewer is available wi hin 200 feed] <br /> Septic Tank: Distance from nearest weII_)e'V__h,,&___D'istance from fourillafio ---J__t�L---------- eridi----------------- J", <br /> ----- ------- -- <br /> .......... <br /> No. of compartmerifs-__1�) 46-�,N depth ----- -------------- <br /> Di�spnsa Field: Distance from nearest well-11- . Distance from fo ion---- Q). to nearest lot line <br /> -- -------- - ,.Width of french.___.--- --4-"------------- <br /> Number o' lines___._----- ��e fh of sac ------- <br /> "Type of filter material_____ D nferial- <br /> c Iengih__ <br /> Distance to nearest well -- --- ----___Olsten" f f C�,,�tne to nearest lot line_________________ <br /> itoun�dpafi-- -------- <br /> _,9 eepa <br /> tris N bar of pits Lining mate----------- .........IS' iameter--.--------------- ----Depth---------- ------------------ <br /> _i is t, <br /> Cesspoo :d)., P istance from nearest well- rice fromfou fion. - --------__...Lining material_______________.__.__.___-.__.____-_. <br /> F-1 Size. Diameter---------------------- ...... eol�_--- ------------- ----------------------------Liquid Capacity----------------;-----------gals. <br /> Privy: Distance from nearest we]- - - - -------------------- -----Distance from nearest building___"_.____.__________________________❑ -- <br /> Distanceto nearest lof line A --- -------------------- ------ --------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------- ------------------------------- <br /> rl----- -------------------------------------------------- ---------------------- <br /> - ---------- ---- <br /> ... --------------- --------------------- ----- ------ <br /> ---------- <br /> -- ------------ ------ --- ----------- ------- ------ <br /> ----------------------------------------- -A ----------------------­--- ----------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have ve ppreypa d this application nd that the work will be done in accordance with San Joaquin County <br /> rules <br /> ordinances, Sfaf I S, and ules regulations of the San Joaquin Local Health District. <br /> (Signed).----- _ <br /> ------------- ------:----(Owner and/or Contractor) <br /> By--------------------- _------_-_--- ----------------------- ------------------------------------------(Title)_ ---------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relafion to wells,0 buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- -- ------------------- ---- --------------------------------------------------- DATE <br /> REVIEWEDBY-------------------------- ----- ----- ------------- -------- ---- ------- -------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED--------------------------------- -------- ------------------------------------------------------ DATE------------- ---- <br /> ------ ----- <br /> W <br /> Alf atio7,qn /orre mme i ns ...... --------- ------------------------------------------------- <br /> -- --------------------------------------- <br /> -- --------- - ----------- -------------- - - -- -------- - --- ----­��---------- ---------- ---------------- ------------------------ ------- -------------------- <br /> ----- ------- P-- ----- --- <br /> 42. -------­------- ----- ----------------- ------------- <br /> C------------------- <br /> ------ --- --------------_ ...... <br /> 7 WZ� ---- ........ <br /> to, —— _-- .-A- --------- ------- <br /> FINAL INSPECTION BY:.----- - Date-- S_-.2........ <br /> fv J A UIN LOC,A,/LSH ALTH D7ISTRICT­ <br /> 30 South mai-36 rest 300 es ak r Street 014 North "C" Street Aw" <br /> S n Calif is Lodi, California Manteca, California j Tracy, California <br /> 4, <br /> 143446 A?WC <br />