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P"mit <br /> APPLICATION FOR SANITATION PERM ;__11 <br /> (Complete In Duplicate) vl�jl Date Issued .... <br /> ,eft i the work herein described- <br /> *,, 1 1 • <br /> a San Joaquin Local Health District for a permit to cons+ruct and instal <br /> Applic�t�ton is hereby made to the ce No. 549. <br /> This application is made in compliance with County Ord;nan <br /> 9, .9,72 .. .................................................. <br /> JOB ADDRESS AND LOCATION_ .0..... lcl_e"je <br /> ... Phone..._.............................. <br /> 1 Ipm 15 IP. ........j......... W.-e <br /> Owner's Name... .................................................. <br /> Address...........—P. ........ none... <br /> Contractor's Name...... . .. . Commercial [3 Trailer Court [3 Motel 0 Other <br /> Installation Will serve, Resiclonce 0 Apirtment House 0 baths 1POL Lot size .....1,5..P....................... <br /> Number of jiving units: ..... - Numbnr of bedrooms .... ... Number of be <br /> Community system 0 Private Uk-fopth to Water Table ........ ft, <br /> Watrr Supply: Public system 0 C; Clav[3 Adobe00'Tlardpan 0 <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandi Loam 0 Clay Loam <br /> Previous Application Made: Yes 0 No 0--"New Cons4uction: Yes 9 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 40.I. .........Material............... .. <br /> ..... ......................... <br /> Septic Tankt Distance from nearest well................Distance from foundation.....I <br /> ....size............................Liquid depth.........................Capacity....................... <br /> 1 <br /> No. of compartments..... ............. inclation.... ........ <br /> wejI.'3.*Q...i;?..'...Distance from fou .L?.........Distance to nearest lot line,../ <br /> Disposal Field: Distance from nearestAp I................ <br /> Number of lines......../.Ir . •..Length of each line.-....14.40•....*r-...Width of trench..---!v:2L11' <br /> Type of filter material., I.... ...Depth of filter material...4..Ir............Total length.......J.h_ja.......... <br /> Seepage Pit: Disti-.-.ce to nearest well .Distance from foundation............„.—..Distance to nearest lot line••••••••••••••••• <br /> Lining material.......................Size: Diarneter...­­.."..­Depth................... <br /> ............. <br /> ❑ <br /> Number of pits.....j.............. <br /> Cesspool: Distance from nearest well.................D istance from foun(.ation............. ....Lining 6aterial.................................. <br /> ...­.Liquid'Capacity...........................gals. <br /> 0 Size: Diameter......................... ..........Depth........................................... <br /> ..Distance from nearest building........................................ <br /> Privy: Distance from nearest well.................................................Distance ..................................................... <br /> 0 Distance to nearest lot int. ......................................... <br /> Remodeling and/or repairing (describe):...*.... . .................. ... ................... ...... i-.•^.:: ...........»..............................- <br /> .................................. <br /> ........................................ <br /> .......................................... ��a;.. ........... ...................................... ......................... <br /> ........................................................................... ............................... <br /> .................... ........ .................................. <br /> ................................................................................................................................................... <br /> .................................. n and that the work will be done in jccordanco with Son Joaquin County <br /> 'y <br /> I hereby certify that I have pmpared this applicaflia Local Health District. <br /> , and rules �iidr)e lotions of the San Joaquin t <br /> ordinances, State laws <br /> ......................JO,~and/ Contractor) <br /> (Signed).. . . ........ ......... <br /> _4 ......(rifle. .........C <br /> kA ...................................................... n be placed on reverse,swe� <br /> .. .._.I.... — buildings. otc., CAI <br /> (plot pis;, thawing she of lot, location of system in relation to wells, <br /> ST USE ONLY <br /> ......... ......7;4 <br /> .. .................... <br /> APPLICATION ACCEPTED M ........ DATE.......................................................... <br /> ......... ... ......................................................... <br /> ....................................................... <br /> REVIEWEDBy................................ ............ DATE.-.......................................................... <br /> BUILDING PERMIT ISSUED.... .. - .. .. ... . ........ ........................................ <br /> Alterations and/or recommondations: ... ........... ................................................................................................... <br /> ... . ..................................................................................................................... <br /> .......... ......... <br /> ... .. ...... ... .... . .......................... <br /> ...... . .. ........ ..... ... ................I.......... .............................. ....................... <br /> ........ <br /> ........... .......... ............................. .................... <br /> .............. ... ... ............/�� <br /> Date <br /> F11',IAL INSPECOON BY: <br /> SAN J0/,QUIN LOCAL HEALTH DISTRICT $14 Nw4h "C” <br /> 1,10 West 004 Site*+ 132 syeafnaito Street Tracy, C41110FIV:6 <br /> r PN6­1 a <br />