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APPLICAT'.0N FOR SANITATION PERMIT Permit No. .. ..{.-�••I°•(Complete in in Duplicate) <br /> Date'Issueo .f......... ~� <br /> Appliea+ion is hereby made to the San Joaquin Local Health rNslrict for a permit to construct and instaii the work herein described. <br /> This application is made in compliance wit County C�:.ii 'ante sec. 549. <br /> J08 ADDRESS AND LOC TION-.. I J'Yr c.O'. CY•f,�t.. ��..o.......^................... i <br /> �� ��]� ,� <br /> ..........................................��.........I. . <br /> ....... ................ Phone...........-..............._..-..... <br /> Cwner s.NOS ............. ............ .. <br /> Address.--- ......... fl <br /> `,T7Contractor's Name............... ... .��:I: ............. Phone .............................. <br /> ins+afla+ion will serve: .RerdAoilent House 0 Commercial 0 Trailer Court F-1 <br /> Motel ❑ Other <br /> h; <br /> Number of living units: _�..... i lumber of bedrooms....,kNumber of baths ....�.-. Lot size .....� �- g <br /> Water Supply: "Public system [3 Community'systern ❑ Private E), Depth to Water Table .v-. ft. <br /> Character <br /> of soil to a depth of 3 feet: Sand C] Gravel E3 Sandy Loam El Clay Loam El Clay C] Adobe Hardpan <br /> Previous Application Made: Yes C3No L�(. New Construction: Yes It No El <br /> TYPE.'OF INSTALLATION AND SPECIFICATIONS: <br /> `."�'• (No :optic tank or cesspool permitted if public newer is available within 306 fee ) <br /> � . <br /> un rJ....IJeyia ............. .. �1(Y <br /> . Septi Tank: Distance from nearest v;elL.c ........Disi'an a fr�jm`fo tion...... <br /> ', +................Sixe.. e. ..�•.rl-....e..._ .squid depth...-:,1...... .. ..:Capacity <br /> No. or compartments..-. -••,� /`�-- <br /> Disposal f=ield: Distance from nearest well.....7.� Distance from foundation.:.%-.G7.......Distance to nearos tfine....t:r........ <br /> Length of each line---...�. <br /> ..•Width of trench... ... <br /> .,' lrlumbar of lines........ g . ..... _ <br /> r f 1�:............r .... <br /> Type of filler material-.,5.?..7 �- Depth of Slier material.....�..�......... Tata] length.........1 . <br /> f� <br />} <br /> Seeps.; , ^it: Disfanca to nearest well ....................Distance Tram foundotion................. ..Distance +o nearest lot ' <br /> Numberof-pits.......:..............Lining matorial.......................Size: Diameter............-..........Dopth..........1 . .�.�;j ;. <br /> Cesspool: Distance from nearest woil.................Distance from foundation...................Lining material...... -�9...�� 7 <br /> Size: Diameter.................... <br /> ...Li uid Capacity.. s..r7 .gals. <br /> Depth................... q P +y...� '..ga! <br /> O <br /> • ;, . . Distance from nearest building.......................:............••••• <br /> Priv Distance from nearest well................................................. <br /> Y :. <br /> Distance to noarest lotline................................................................. <br /> .Remodeling and/or repairing (describe):.� _...... ... .... <br /> ... <br /> a <br /> ................................... .............._... <br /> ........ .................. ........................ <br /> r <br /> I hi-reby-certify fhat I heve prepared+his application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta laws, and rules and regul 'ens of the San Joaquin Local Health District. �s <br /> signed �t 1 . <br /> Ctor) <br /> ........ ......_(Owner and/or Contra <br /> ... ......... <br /> - <br /> z <br /> ................. ..:......................g..................(Title)..... .........-.........-..-............. <br /> y ..................... ] t <br /> [Plot plan.showing size of let, locatian of s stem in relation to woils, buildhi s, etc., can be laced on reverse side. r.. ' <br /> FOR DEPARTMENT USi ONLY '. <br /> APPLICATION ACCEPTED BY..................... ATI.............. ./. ...... <br /> !•- �................ <br /> DATE �( .................... <br /> REVIEWED BY... <br /> .......-. i2 - <br /> III111����'' DATE......1. -..... .- <br /> : <br /> BUILDINGPERMIT ISSUED.,................................................................................................... <br /> _ Alterations and/or recommendations:................................................... .................... .......--............................... .. <br /> .. ......... <br /> ................................................................I............. <br /> ............................... <br /> ........ ........................ .:..................-.-........ .............._.......... ....... <br /> FINAL INSPECTION BY:...:.. ... „ ._, 4 <br /> Date... <br /> t �v SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> (� r <br /> 13D Soul}, American Street 3D0 Wes} Oak Slrea` 132 Sycamore Sliest 814 Nor11, "C"Slreal <br /> Tracy, California n Stockton, CaliFprnia Lodi, California Manteca, California <br /> :rh <br /> i <br /> ES-9-2M;: flovised W2100 <br />