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Permit No. ............ <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> WDate Issued ----5-7 Az. <br /> [ Ij <br /> Applica+ion is hereby made to the San 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 L��ATION__4_AM------AAZ-------41060tfl:!�".-•------...—do. ------------------------------------------------------------ <br /> Phone------------------------------------ <br /> Owner's Name-----------67Am?. . . 0 ----------------------------------------------------- - ------------------ ----------------- ---- - <br /> -4----- ---------- ---------­---------------------------------------------------------------------------------------------------------------- <br /> Address-----_-------------------- 4474k, ------ <br /> Contractor's Name------ ---------------- --------10:20.4-15;r2ow------------------------------------------------------------------------ Phone------------------------------------ <br /> Installation will serve: Residence Apartment House [] Commercial [] Trailer Court E] Motel 0 Other [3 <br /> - <br /> Number of living units: Number of bedrooms ----t Number of baths Lot size --- ------------ ---- <br /> Wafer Supply: Public system Community system El Private [I Depth to Water Tabled ft. <br /> Character of soil to a depth of 3 feet: Sand'E] Gravel n Sandy Loam El Clay Loam [I Clay E] Adobe[Ao-Hardpan E] .A' <br /> Previous Application Made: Yes E] No Zk- New Construction: Yes E] No Z?- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:. Distance from nearest well__,_________._--Distance from foundation___________________Material____.._________---.---_-_____________-_.___._:_. - <br /> ElNo. of compartments---- -------------- ---Size--------------------------------Liquid d"epth--------------------------Capacity,------------------- <br /> Disposal Held: Distance from nearest well___.._______..._Distance from foundation---------:..........Distance to nearest lot line-____-__--__-❑ <br /> Number of lines--------------------------- --- --Length of each line-----------------------.----._-Width of trench.--------.-----_ - ----- ---: <br /> Type of filter material----------------- -------Depth of filter material-------------- Total length------------------- ---------------- <br /> foundation_. -once o in ne-- - --------- <br /> Seepage Pit: Distance to nearest _�O­­_.Disf $ f nearest lot li- <br /> well....11#4---------Distance from <br /> Number of pits-------/_-----------Lining material iadA-A�01ttize: Diameter_.-NU_........Depth------ 4__________________- <br /> Cesspool: Distance from nearest well----------------Distance from foundation - -----------------Lining material------ -- ---------------------------- <br /> ❑ Size: Diameter--- -------------------------------.--Depth----------------------------- ----------------------Liquid Capacity----------------------- -gals: <br /> Privy: <br /> gaIs- <br /> Privy- Distance from"nearest well.- _______-------------------------Distance from nearest building------- ------------------------ <br /> ElDistance to nearest lot line--------------------------------------------------------------------------------------------:----------------------------------------------- <br /> #4? <br /> --------------------------------------- <br /> '0 pt#,� <br /> Remodeling and/of repairing (describe): ZIA- <br /> ---------------------------------------------------------------------------------­-------------- ------------------------------------------------------------------------------------------­--------------------------- <br /> --------------------------------------------------------I---------------------------------------------------------------------------------......­-------------------------­­------------------------------------------- <br /> -------------------------------------- ---------------------------­------­-_-------------------I-------------------------------------------------:-------­--------------------------------------------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> --A <br /> 7— <br /> (Signed)----------I ------- ----------- ----------- ------------------------------------------------------------=-----{ Contractor) <br /> -----------1------------------------------------------------- -----(Title)-------- ----------- <br /> By:-------- --- <br /> (Plot'plan, showing of <br /> lot, location of system in relation to wells, buildings, efc., can be placed on rev rs s e). <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------------------- D AT Ekr_%l-------------------------------------------------! <br /> APPLICATION ACCEPTED B ---- ---- <br /> REVIEWEDBY-------------------- ---- ----- -------- ------------------------------------------------------------------------- DATE--,A-s-------- ---------------­.­----------------: <br /> C <br /> TE---- fk <br /> BUILDINGPERMIT ISSUED------------------------------- --------------------------------------------------------------------- DA - - --------------------------------------- ------------ <br /> Alterations and/or recommendations:_,-- ------ ------------------------- -----------1*1- ------------------------------------------------ -----------------------------------I--------- <br /> :: <br /> -------- ------------------------- .. --- -------- - 7-- /1) 0 <br /> - ----------- --------- ----------- <br /> 13 -- --- / - ----- V-- � <br /> ----- - ------- ------- ---------------------------- ------------ <br /> t. <br /> ------------ <br /> ---------------------------- -------- --- ------- <br /> ---- ----------------- ----------------------------- <br /> ----------------- ---------------------- ----------- -------- ------------------- -------------------------------- ----------- ------------------------ <br /> .. . ... ---- ------ -------------------------------------__--------------- - ----------- --------- --- ----------------------------------- --------------------- <br /> ---------------------------------------\....... ------------ <br /> FINAL INSPECTION BY:------. ---------- --- Date----- 7-------- --- -------- -------_-------------------- <br /> -----�JL"S_-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Sfockfon, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOO W-K, <br />