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------------..._......................... <br /> ---_-------- ----------- - APPLhee,,,,nON FOR SANITATION PERMIT *m/ Permit No. <br /> `............ ..... .._ ...... ........ (Complete-in Duplicate) Date Issued <br /> ._..... .... This Permit Expires 1 Year From Date Issued <br /> )plication is hereby made to the San Joaquin Local Health District for a permit to cons ruct and install the work herein described. <br /> ..4s application is made in compliancy with County Ordinance No. 549. p� <br /> B ADDRESS AN L•O�C�A�TION. ..z7� %... talo s ? l �� .....!... .F>�'...�- L......<<........-•-- <br /> 1 u`r'•------- <br /> e mer's Name........Krti: k` -- - .. .E... .. - Phone--""......-'--....._......--- <br /> Address------....- --- - - ?as.L------- <br /> ..... ------- <br /> .. ................ntractor's Name----"- - ... ... . ... .............. Phone......................_... <br /> Installation will some: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ../... Number of bedrooms _7/Number of baths _/... Lot size ..: 2----------------_..----- <br /> rlter Supply: Public system ❑ Community system ❑ private [Depth to Water Table ...... . ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel C] Sandy Loam E] Clay Loam C3 Clay [Adobe ❑ Hardpan ❑ <br /> vious Application Made: (If yes,date....-_......__-. I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> i PE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> >tic Yank: Distance from nearest welL....J®......Distan�e from �oundation....L.O.._.._.Material ..:�G7 _ <br /> �•�.............. ........ <br /> ` .... <br /> [e No. of compartments---------7�--------- Liquid depth..... ....... ....... Capauq.J.OU/ <br /> �'-oos Field: Distance from nearest well...f�.....Distance from foundation..,,.&...........Distance to nearest lot lines..`r <br /> Number of lines........../... ..............Length of each Iine.. .ZeO7..............Width of trench....�z.------------------ <br /> ..... <br /> her <br /> Type of filter material.......... ......Depth of filter material.......�.fL."......Total length.....10Q..�.-....................... <br /> i01 <br /> _! pit: Distance to nearest well.......tg.! ......Distance from foundation...../..A..........Dlstance to nearest lot line.$......._.... <br /> Number of pits... ..? .......Lining material.........5../Z---. Size: Diameter......2.1.".....Depth......x.s._'............... <br /> We, <br /> :esspool: Distance from nearest well ................Distance from foundation.-............... ..Lining material..........................._........ <br /> ❑ Size: Diameter. .. ......... .... ................Depth -' -..... ...----.....'- -'--" ........Liquid Capacity-'-.....................-gals. <br /> Ly: Distance from nearest well.................................................Distance from nearest building.......................... <br /> ❑ Distance to nearest lot line.-..............................---.......-_..-----..:.........._....._.._----------------....................................'-'-- <br /> p nodeling and/or repairing (describe):--.Z.4­1 <br /> -... . .......... . .---------1 -------------"---------^----•----------"'---......--------•-----._...----------- <br /> L...._............. _ rte.-. ,. -- - ..---•--'------...................-----'----....................-......... <br /> . ......... <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ardlnances, State le nd rules and regulations of the San Joaquin Local Health District. <br /> nod).............' '^..._�....-.....�..... -' -'---.......... ........ r and/or Contractor) <br /> By ........ .! ....> l......_ ............ _._.................(Title)................. .._._ _.__.... - -- ..... _ <br /> Plot plan, showing size of lot, Iota+ion o system n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY / �+ <br /> o,PPLICATION ACCEPTED BY_.. . - - - ----.....-- ---------------------------------------- DATELi..'.L=+..:�97- - ..... <br /> 2 IEWED BY............. --- - ........ -'............... DATE.......... <br /> ---------------------•----------- <br /> ---------- <br /> iLheDINGPERMIT ISSUED........ .. ................-................................-................................._... DATE.................-•-----'-----•----•------.._�..__ <br /> 41terations and/or recommendations:.. --------......_... ............ ....•-•----............................................ - - -- - <br /> .. <br /> ........................"-................................._................ ............................_.. ..'- ..........._.............. <br /> ............. .......__...._... _....................... ......_............................................................................. --... -' .._....-----'-----'-'-'••-.............. <br /> FINAL INSPECTION BY:..�I,i�z ................... Date.. /11i3�G <br /> ......-. ....'-............... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.H...It..Ave. 300 West Oak Street 174 Sycamore Street 205 West 91h Slreel <br /> St.6toa, Callfarnla Lodi California Manteca,California Tracy, California <br /> E. 2M 1 67 Van9�ard Press <br />