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� <br /> � <br /> APPLICATION FOR SANITATION PERMIT Permit No. . <br /> . -~ ~ �mOu��m|e � <br /> ' - ' ' Duplicate) Date |,�e6 -�^�����.l.. <br /> Application is hereby made to the Son Joaquin Local Health Dist rifor� o permit toconstruct and installinstallthe work herein described. <br /> This application is made in compliance with County C},6inonco No. 549. <br /> /�|_- <br /> JOB ADDRESS AND LOC/�T|(] / --�1Z��-----------.-.---.--_.- _. ---- <br /> Owner's Name_--------_----------------- -------­-------------'^-- Phona'' J~-00'L�' <br /> Address------------------------------------------- <br /> -.___6�__�� _._._______..--._ _______.,.__.__._._- ------------ <br /> Contractor's Name-------------------------------------------- .---------------------------------------------------------------------- Phone---_--___- � <br /> |nstaUa+ion will serve: Ro,k]mnca ortmont House E]' Commercial [] Trailer Court [] Motel Other E] <br /> Number of living units: .)..lWwmbn, ofbedrooms:33.. Number of bath o`.� - Lot ---_-------------- <br /> Water Supply:Summly: Pub|ic system El ' CommunHy system'El Private W Depth to Water Tu6|e4�-�ff. � <br /> Character of soil f <br /> to a depth of � eet Sand <br /> an6 E] Gravel E] Sandy Loom E] ClayLoam E] Clay [] Hardpan [] <br /> Previous Application Made: Yes E] N"^�z/ New Construction: .6o [� No`�" PHA/-VA: Yen | NoEj -' <br /> TYPE OF INSTALLATION AND SPEC|HCATK]NS, '- � <br /> (No septic tank or'cesspool permitted if public sewie, is available within 300 feet.) <br /> Disfunco from neunesf *uU-----Distanco from foundation-'�_---k4ofeviuL-_---_-'_-----_ , <br /> - Ili»~'Tank- No. of compartments-----_----Size_--___----_'Liquid 6eA+k--_-'------------Capacity_--.---- | <br /> Dispoaal Field- Distance from nearest wo| �---------Disfance from foun6otion'4 ��--'Distunce-to nearest lot <br /> �O Number of lines----------------------------------- of each |ine.--.--.—__�/�fh of��n;k--. � <br /> Type ofUhar mo+erivL------.'D�of of filter mu|e�nL__-.--Tof | length-----����(�.---'- <br /> � ^ <br /> Se000mu Pit: Distance to nearest well--------------------Distance from foundation------------------Distance fo nearest lot line-.''-'--- <br /> Nvm6urofpits------ ---------------Lin�ng material ---------S'�zo: Diomr+ec.__ -Depth---- - --._---. J <br /> Cesspvv|: Distance from ne*,a" well-----------------Distance from foundation------------------- Lining muteriuL---_---_-._ - <br /> [] Size7: Diameter'-''---''-�­'- - -Doof h''-''''--''--'''_-''-_.Uquid Capacity '----'--'--.gals. <br /> Privy: ' Distance from nearest °e|L-- ----- ----------------------------------Dis+ noa from noona,+ buiW;ng---------- -------­ U <br /> [] Distance to nearest lot line-----��-'��- '�-'''_'-, -~_. - =. ' � <br /> - ' �� �� ��� --'-_- -_�' __-'----'''-'-''-'�-��- <br /> Remo6eing and/or repairing (doozibe)----------------------------------------'__-_-------------------------------------------------------------- -.----''-_-'-- <br /> _—__.____.----__--__-------_^-----.__._-__-_--_----__--_'-_---__._--._--.—.. <br /> . `~ <br /> ---'--_----'_-------'--------^---___.-'''------_'--_.'-_.--__'-_--�_-'''''-''__---'-'_-_-'-- <br /> --------------'------------'-----------_�������������---------------'������������������--------------'-------'---------------'�����---------' <br /> / hereby certify that I have prepared this application and that the work will be d6ne in accordance with San Joaquin County . <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health DiSfriCf.r <br /> ;x -- ------------------------ (Owner and/or Contractor) <br /> By--------------------------------------------------------------------------------------------------------------------------------------[[if 191-----.------_----------- <br /> (Plot plan, showing size of lot location of system in pe|mSpn to wells, 6ul|6|ngs, p+c. can be placed on reverse side]. ' <br /> ' <br /> FOR DEPARTMENT USE ONLY <br />� ou/uu/nG rExm// ISSUED----..------_--_---- u*|E--------------' <br /> Alterations and/or recommendations:------- ------ ------------------------------------------------------------------------------------------------- ____._--____.. <br /> ____ <br /> '—~JlJ ` <br /> —'------'- '-'-''- r ' - ''--'''-~''''' ''--'-'-''-'- <br /> -�JL�'��l�jW�1 ' <br /> FINAL INSPECTION 8Y--- — ---------- ------------------- —''-''--' <br /> ' 5ANJOAQU|NLOCALHEA[THD|STRICT <br /> /am so"m American Street 300 West Oak Street /mc Sycamore Street 814 w"*h "C" Street <br /> smokt" . California Lodi. California Manteca, California Tracy, California <br /> sS-9-2w . xo"a°v 1.57 pP.cu <br />