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PERMIT Permit No. <br />APPLICATION FOR SANITATION <br />.(Complete in 'Dupllcate) Date issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri e, <br />This application is made in compliance with County Ordinance No. 549.tj ----------------------------- ------ ------------ <br />------ -- -- -- ----- �;�4 <br />JOB ADDRESS AND LOC TION__.._ ... ... , <br />---------- <br />Owner's Name---- ---J------------- ------------------ <br />---------- --- --------- 11 --------- -------------- ------------ n <br />Address_,2�__ ----------------------------------------------- Phone '17 <br />OtherContractor's Name-____-- -- ------------------------------------------- ---------------- E] Motel i�� 0 <br />Installation will serve: Residence Apartment House Ll Commercial [I Trailer Court El ----------------------- <br />Install X_ ?__ Lot size <br />I Number of bedroom, Number of baths <br />Number of living units: -,7-- stem 0 Private El Depth to Water Table��Tf_ Hardpan 0 <br />Water Supply: Public systeMN171 Commun%'Ify Sys Clay [] Adobe <br />/­ Sandy Loam 0 0ay Loam D <br />Character of soil to a depth of 3 feet: Sand D Gravel 0 <br />s Application Made: Yes C11 No)K, New Construction: Yes E] NX FHA/VAE] No <br />-TS <br />Previou <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or` cesspool Permitted if public sewer is available within 200 feet.) aterial -_-CaAacit <br />No. Tank: Distance from nearest well ------- I ---------- Distance from foundation -------- dep�h M --------- -------------- -------- <br />�k ---- Size ---------- ---------------------- Liquid ------------ Capacity <br />No. of compartments --------------------- Distance to nearest lot line-`-._----------- <br />Distance from nearest weil........ Width of french ----------------------- <br />(��;% Distance reach <br />Disposa field: ---------------------- Length of each line ------------------ <br />Number of lines ------------- ---Depth.-Qf filter material ----------------------- Total length ----------------------------------- <br />f filter material-________________----- <br />Type 0ice TV)�n fou Distance to nearest lot line__ T-- <br />- <br />S, e Pit: Distance to nearest w61lP__7­f-­v?r ------- DistaT Size- Diamefer____V to ----- - ---------------- <br />See 3e P L , ining materle ----------- Depth <br />Number of pits ----- --------- 'Lining material__-__-_____------------ --------------- <br />Distance from neares+.well ----------------- Distance from foundation____--__----- ----- - - Liquid - Capacity --------------------------- ga!"�.. <br />Cesspool Size: Diameter----- ----------------------- ---------- Depth ---------------------- ------------------------------- <br />171 bistance from nearest.well----------------------------------------------- Distance from nearest building____------------------------------ ------ <br />Privy: Dista . nce to nearest lot line -------- ----------------------------------------------- - -------------- ------------ ---------------------- ------------------------ <br />El <br />Rem g and or repairing describe}:--- r ------------------- --------- <br />o -------- ----- ------- -------------------------------- <br />---------------- ------ ------------ - --------------- <br />- ----------------------- ----------------------------- ------ ------------------------------------------ - <br />- - - ------------------------ ----------- ----------------------- -------------------------------------------- ----- ---------- <br />--------------------------------------------------- ------------- ------- ------------------------------------------------------------------------- <br />- ----------------- ------ --------------------------- ------------------------ n accordance with San Joaquin County <br />k will be done i a <br />---------------------------------------------- ation tha he wor <br />fy that I have pr par this aPP11c <br />I hereby certify - Health District. <br />ordinances to la rules d lations. o e n Jo in Local or <br />/or Contractor{ <br />---------- (Own <br />----- ---- ------ - ------ - -------- <br />(Signed)- ____ - ___ --- _ X — - <br />if Ue - --- - - -- ------- -------------- <br />----------------------------------------------- : --------------------- (T d <br />f <br />by:----------------- ------------- etc., can be cod on reverse e. <br />in relation to wells, buildings, <br />(Plot plan, showing of lot, location of system <br />FOR DEPARTMENT USE ONLY <br />ATE------ ------ ------------------ <br />---------------------- D --- -------- <br />APPLICATION ACCEPTED BY ----- 77715%-K!_0­0 ------------------------------------------------- ---- --------- ---- <br />DATE ------------------- ------------ <br />REVIEWED BY ------------------------------------- -=---------------------------- <br />--------------------- DATE ------------------------------------------------------------- <br />BUILDING PERMIT <br />-------------------------------...I.S...S..UED ----------------------------------------------------- --------------------------------- - <br />Alterations and/or' recommedations----------- ---6 ---------- <br />--------------------------------------------------------- <br />--------------------------------------------------11---------------------------------------------- --------------------------- <br />- <br />- ---------------- <br />------------------ ----------------- ----------- ------------------------------------- ------ e----------------- ----------------------------------------------------------------------------------- <br />--------------------------- <br />---------------------------- <br />------•------ <br />------r ------------------------------------------------------------- <br />- <br />- <br />----------------------- ----- ---- - --- - --------I ----------I --II------ <br />----------------- ------------ ---- ------------ ------------------------------ <br />---- <br />----------------------------- <br />---- -------------Date------//---r ----------------. ---* <br />q-------------------------------/- <br />�N <br />bs <br />FINAL INSPECT[ BY - ------ -- -- ------------- -- ------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street <br />13o South American Street 300 <br />West Oak Street 132 Sycamore Street Manteca, California Tracy, California <br />Stockton, California Lodi, California <br />ES -9-2 M , Revised 1-57 F.PCO- <br />