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FOR OFFI�;FIUSE:, �Aj <br /> P------ Permit <br /> -------- PLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> -------------------------- Date Issued --- <br /> . , This Permit Expires 1 Year From Date Issued <br /> --- ------- ---- -- ---------------------- ------------- <br /> Applicartion is hereby made to the San Joaquin Local He6i.Ifh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance Nv 549 �12 <br /> ------------ ----------- <br /> - -------------- <br /> -------- --------1-------- ... b <br /> JOB ADDRESS AND LOCATION---------- --- -------- -------- ----------- 7 <br /> . I Phone- '0, _34�� <br /> Owner's Name_a-------- ---------- ------- ---------------------- ------ ----------------------------------------------- <br /> .................... <br /> -------------------------------------------- ------------ <br /> Addres5-------�- ----------------------------- -------- Phan <br /> ----------------------- <br /> Contractor's Name----------- ----------------------------------------- <br /> Commerc' Motel El Other <br /> Installation will serve: 'Residence Apartment House Commercial E] Trailer Court ED <br /> xiNumber of living units: ber of bedrooms _3--- Number of baths Lot size .___11 ❑ <br /> �e... ---------------------- <br /> 1 <br /> Water Supply: Public system Community system D Private El ' Depth to Water Table--54- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam El Clay.Loam El C]Clay 'Adobe 2'-.'Hardpan 0 <br /> Previous Application Made- (if yes,date_..- 7------ -) No 0 New Construction-. Yes 0 No HA/VA: Yes [] No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200.feet.) <br /> Distance from nearest well----- -----------Distance fromJoundation--------------------Material------- ----------------------------------------- <br /> No. of compartments------------ -------------Size"-------------------- Lig(ji,d depth---------------- ---------Capacity----------------------- <br /> 'N <br /> 1 al F' Id: Distance from nearest Weil-----------------Distance from.,foundation—----I------------_Distance to nearest lot line...____.._______. <br /> Number of lines----- -_Length of each line------------------- ----------Width of trench-----------•------------------------ <br /> --------------------------- <br /> Type of filter epth of filter' material-------------------- Total length---- ----------------------------------/- <br /> __Distanc))to nearest lot line--,1159------ <br /> Seepa Distance to nearest' W-1 --Distan e m f riclation- 0___ <br /> Lining material--_ Diameter---- Dept ----------------- <br /> Number of pits_"---- -----------Linin --------:----Sixes <br /> :------------- -�el"611_f----T <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_-_______..____---------------"-els.gals, <br /> 0 Size. Diameter.--------------------------------------Depfk------------------:--------------------------------Liquid Capacity_------ <br /> -------------------Distance from nearest building-------I------------ -------------- <br /> Privy: Distance from nearest well___--- ---------------------- ------- <br /> ❑ <br /> Distance to nearest lot line---------------------------- - -------------------------------- -------­-------------------------•--,_t---------------•-------- <br /> Remodeling and/or repairing [describe):-' -------- ---------------------- <br /> ---------------------------------------------*----------------------------------------- <br /> ----------------------------* I <br /> If---------------------------- _­------------------------------------------------------------ <br /> ---------- <br /> IG <br /> 2 ---------1_�-----------------------­-------------------- ----------------------------- <br /> -----------:---------------------------- ------------------------------ ----------_-------------------------------------------- 4 1 <br /> i I I I I ----------------------f--------------------------------- ----------------------- <br /> ------------------------------------------------------------------------------------- <br /> ----- --- -------- <br /> ---------I__hereby- --__certi-f-------a h-_ve prepared this application and that the work will be don'e'in accordance with San Joaquin County <br /> a P <br /> State an regulations o!!:he a oaquin Local Health District. <br /> ordinances,y1ale �aw)s and rules Sa <br /> . ......... ......... <br /> wrier s <br /> nd/or Contract------------------ --------------------- <br /> jSigned) ---- --------- ----- -------- ------ - ... .-- - -------- --------------------------- ----------- - - ------------ <br /> By:----------------------------------------- --------- <br /> t", 611s,buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, locaflon of system in relafto"In't <br /> .'FOR DEPARTMENTUSE ONLY _ <br /> APPLICATION ACCEPTED BY---------------- -- ------------------= <br /> ------ DATE-------- ------------------------ <br /> ----------------------------------- <br /> ------------ ----------- <br /> REVIEWEDBY----------------------------------------------------------' <br /> --------------- <br /> D DATE----------__---------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------x.- % <br /> ----------- - -------------------------------- -------------------------------------------------------- <br /> Alterations and/or recommendations:------ ------------- %. <br /> -------- ------------------ -----I--------------------­-I----------------- -------------------------------------------I--------------I---------------------------- -------- <br /> --------------------------------------------------------------- -------- -------- -----------------------------------------------------!t------------------------------------------------------------------------ <br /> -------------------------------------------------------- ----------------•----------------------•--------------'t -------------------------------------------—--------------------------------- <br /> --------------------------------- <br /> ----------------- <br /> ---'-------- rr 4 <br /> FINALINSPECTION BY:-----------13�-•--------------'------ ------ Date-------- --------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Siockwrlr California Lodi,California Manteca,California Tracy,California <br /> E5-9 REVISED 9-59 F,F-=C-2M 6-60 <br />