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Perrivit No. <br /> APPLICATION FOR SANITATION PERMITT _ <br /> (cmplo% ;n Duplicate) Date Issued <br /> 4 <br /> and install the work heroin described- <br /> Applica+*ton is hereby made to the San Joaquin Local HealibDistrict for a permit to construct <br /> 171 <br /> mpliance with County ordinance No. 649. <br /> This apptication:is madeiin co, <br /> 0.S- A- <br /> .71......J&I ... ....at.us�k <br /> JOB ADDRESS AND ATIO - ------------ no .................. <br /> M07.. . . .......................­­- PIT ......... <br /> Owne'r's Name._........... C,4 I— <br /> ............... <br /> 71M- ... 114 1 <br /> Address__.. --------- --------------- — p6one. <br /> ................. <br /> ........................................... <br /> Contractor's Name.... - AbN _27 <br /> • <br /> Installation Will serve: Residence 0 Apartment House 0 Commercial Pk Trailer Court 0 MOW 0 Other 0 ........ <br /> 'i S .... <br /> Number of living units. .-------Number of bedrooms_v�Nurnber of both j_WaLot size ter Tablely...it. <br /> Water Supply. 'Public system 0 Community system [3 Private 5Q Depth to <br /> lay Loam 0 Clay 0 Adobe K Hardpan 0 <br /> Chara0ar of sell to a depth of 3 feet: Sand C1 Gravel 0 Sandy Loam El Clay <br /> previous Application Made: Yes 0 No Now Construction-. Yes [3 No <br /> TYPE OF INSTALLATION AND SPECIFICATpubSl: <br /> i o6le Within 200 feet-1 <br /> (No septic lank or cesspool perWilied iic sewer is aval <br /> Septic Taink:.p4g Distance from nearest wall._....r._._:... from <br /> four atia�n_ <br /> No. of compartments----------- O.-SiZO-------------------­­—Liquid depW--_---------------------C81Po4tY-----•-------- <br /> n foundation-.7 <br /> _gOL7 'Distance from ;5 <br /> ........Distance to nearest lot <br /> Distance from nearest well. . ___ r 11 <br /> Dis osal Field: .-.Width of trench-._I_A� .................. <br /> Number of lines. Ow, ........Length of each line--s-11-0 -Total lenc�h ..----•--•••-* <br /> . <br /> Type of filter materialfoRb.Cite-Depth of filter materi <br /> If <br /> CZ Tdation-/'1,-!C._Dijance to nearest 1pt <br /> Distance to nearest well../.. w--- <br /> .well../...---...DistiinceArom fou <br /> Seepage Pit: Number of p;ts.Aj).1 -�ateri Size; Diameter.-.-- ......Depth-.-A. .................... <br /> A e.,—--------Lining i ial.,jP ----------------Lining materilal...............---------------- jCesspod:. Distance from riearest well------­---------Distance trorn'foundation- .................joi <br /> ClSize: Diameter--------------­....................Depth...... ................................—.......Liquid Capacity....... <br /> Privy:; Distance from nearest well......................... <br /> ................------Distance from nearest building....................................... <br /> 4.0 <br /> ......................................------------ <br /> Distance to nearest lot-line-----..........................................—---------- <br /> ❑ <br /> Remodeling and/or repairing (describe):---- --- - ---—-i­­...... <br /> ....VW------- <br /> ............. .............. .I............. A .................... <br /> ................ <br /> .................................­­­............. . ...........------- <br /> --------I hembertify that I have prepared fhis application and that f6 woA will be done in Occordsm"dh San Joaquin County <br /> ordinance;, Ste r5aW. nd rules and regulations of the San Joaquin Local Health District. <br /> r ;A <br /> (Sig --------------- ::Z......----------_------_-_---.-J0,mor and/or Contractor) <br /> ned�............. <br /> By:............... z...... 'Wings, etc, can be P6.;9on reverse <br /> '(Plot plan.showing size a W, location of system In relation o buildings, <br /> side <br /> FOR DEPARTMENT USE ONLY <br /> DATE------------ <br /> APPLICATION ACCEPTED BY.---------- --------------------------------.... ----------------------- <br /> REVIEWEDBY_---_------_----------------------------_-............................ ............................................ DATE._...............------...........................•.--•---. <br /> BUILDINGPERMIT ISSUED--_-_--------­___....................-•--•--------------------•--.....-•---......... DATE-------------................. -------- <br /> Alterations and/or recommendations:-------------------------------­1........................................................................... <br /> ......­1....1--.............................I......................................................I......................................................................................................... <br /> .............I........ .............................. --------­---*...........*-----------­-----------*................*.......*............ -------------**­_­_­___­-------- <br /> ......................... <br /> ............__­.........................-....................­­­...............­11............................I...........................I.................I.......... <br /> ----------—................................................................. <br /> ................................�­................................................ <br /> Date............ ...... .............. ......................... <br /> FINAL INSPECTION -BY:........,- A --••----. ------- <br /> SAN <br /> ----­SAN JOAQUIN LOCAL HEALTH:DISTRICT 814 harth "C"Sm <br /> lie SwA American Stmat 300 W40f Oak Street 132 Sycamore shool <br /> stock4on, California Lodi, California M,nfoaa,Car"Mix Tracy, Callfarnim <br /> ES-4-7M; ,Revised W-2100 <br />