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� APPLICATION FOR SANITATION PERMIT Permit - <br /> in Duplicate)m <br /> (Complete- ,�---' Date |ounJ <br /> plication is hereby made to the <br /> San Joaquin Local Health District for a permit to construct and work herein described. � <br /> 's application is made in compliance with County Ordinance No. 549. <br /> ^^'" '`°"~`^^ AND =-----'---------'-'------ <br /> ------------------------------ --------- 7. <br /> Address,--- '------- --------- -- '--'—'--'' - - i <br /> . <br /> Contractor's '`a""=-- --- �t==,='---'-------- ' '""'�'�`-,''=��,-=`-- | <br /> Installation will serve: Residence [] Apartment House 0 Commercial Trailer Court E] Motel [] [)Mhar E] � <br /> � <br /> Number of living units: '------- Number nfbedrooms ---------------- Numbe, of baths ---------------- size - /�'���� ' <br /> Lot �o ' . v°�.���^1,570------------- <br /> Wafer <br /> --''Wafer Supply: Public system De Community system El Private R Depth to Water Table _4_/__0 ft. <br /> Character of soil to a depth of feet: Sand E] Gravel Ej Sandy Loam [-] Clay Loam [] Clay E] A6o6uX Hardpan [] <br /> Previous Application K4m6o. Yes E] No New Yes [� No �JK <br /> �r <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> � (No septic tank nrcesspool permitted Rpublic sewer is available within 200 feet.) <br /> To k ` Distance from nearest we|L-----Distance from foundation-------k4uterioL----------------- <br /> No. ofcompu�ment,--.------.Sioa..�---------._-Uqvid 6eP+k---..-��----'Capacity---.----'i Field: <br /> ts <br /> - ` - -:' <br /> Distance from nomro, well-----------------Distance from foundation--------- .--'Distoncoto nearest lot line.-_._ <br /> Number o[ | of each knu-'''-'.''-'''-�/�t of �u"c�'-'.-'---_''_ <br /> " « � Typu o��|f�����e,ioL---.----.Depth of �|fnr moferiaL------.-7ota| |ono+ <br /> ' ` � ------------------------------------------r '~-. �N4 <br /> Seepage Pit: Distance | nearestwell N".-. f fq 5- .� D to +| |iZo.. <br /> Numbar of p|�-- - ---Un�ng mat 5b�� ��m�+ec..���-° Dopf --------------- 1) <br /> 51 <br /> Cesspool: Distance from nearest well ''��--Distance from foundation--------------------Lining material '--'-��-'�---__ <br /> Siz=: <br /> . <br /> Diameter-------------------------------------- ------------------------------ ------ -------------Liquid Capacity-.-------------------------- . <br />� <br /> , ~- - �r �r ) <br />� _''--_--- ''_- --.--''-''-'---'--- � <br /> --------''-_w�---��'-----------------------'---'-----'---------------------'----. ----- <br /> ~ �� ^ <br /> '-------------------'----------'--------------'---'-------'------''-r ----- <br /> | m+ | havo' and that the wvr will 6edone inaccordance wMh Sun Joaauin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' <br /> . . <br /> (Signed) ^� --- ---- -------- --------------------------------------------------------- __d(O ner and/or Contractor) <br /> (Plot plan, showing size of lot, locaflon of system in afion to wells, buildings, etc., can be placed o. n reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8)---------------------------------.--�����---__-._-�-- UATE'-- . .. ----------- <br /> REVIEWED <br /> --' <br /> RB4E\�EO BY'''-''---_''-''-'--'-''''-_''--'�����'-''-_.'''---'-' DATE'''----.------'----.'--.'.'_-'- ! <br /> BU|LD|NG PERMIT ISSUED-------------------------------------------------------------- ---------------------------- ---------- DATE------ _-_--.-------.___ <br /> A|tormt|ons and/or recommend afipns:-------------------------------------------------------_--'-_- ---------------------------------------------------------------------------- ' <br /> _-_--------------._------._-_---._--___-.__.----_-_--___-.__.-.----__-__. <br /> -----'---'''''---'-''-''''---'--''—'---'''-'''''-''''--'''--''''--'''-'''-'''----''--'---'--'' <br />� -------'-----'--------''''-----''--------------'-------''-----.------------'----------''---''''---'--'''-----''''---'''----------'-------'-----'''''-----''-- ---'-----'---''�'. <br />� <br />� --'--'---,''---'-''--_'',-'''-'--.-'_-''--_'-''---''''---'''-'''--'''-'''--'''-''-'-'----'' <br />� . <br /> RN/\L INSPECTION 8Y��L���' ------------------- Date-------- ---- ------------------------------------ <br /> SAN JOAQUIN <br /> ------__--SANJOAQ0N LOCAL HEALTH DISTRICT <br /> ' /10 south Amer;ca" street 300 West Oak Street /32 Sycamore Street aw North "C" Street <br /> � S+"ck+o" California L*Ji, C*kfo, ia Manteca, California Tracy, California <br />` cS-9-2w /0^2x",is"J v,-2/00 <br />