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PLICATION FOR SANITATION PERMIT Permit No. 3W----9; ...... <br /> -Z (Complete in Duplicate) <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein descr*0d. <br /> This application is made in compnance with County Ordinance No. 549. <br /> ZY-------- -6171 ---- -- ---------- <br /> Contractor's Name--.. F:77' <br /> Installation will serve: Residence CK Apartment House El Commercial E] Trailer Court [] Motel Ej Other E] <br /> Number of living units-. Y----- Number of bedrooms Number of baths Lot size _i�__W_X--- <br /> Water Supply: Public system A Community system E] Private 0 Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand F <br /> ] Gravel [-] Sandy Loam E] Clay Loam Clay Adobe Hardpan <br /> Previous Application Made: Yes No 19 New Construction: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />' Tank: Distance from nearest weI4VWC__Distance from foundafion-/,O-----------MateriaL____al�_ <br /> No. of compartments ~ ------------`-- --,----- ----------- <br /> Disposal Field: <br /> ---'Dk | Field: Distance from rost - Distance from fnu6 //e ^ /�^ / <br /> Type of filter rnaferiale __ -AX---Depth of filter material--- ----------Total length----o2wr---------------------------- <br /> Seepa e Pit: Distance to noon,st ~e|L D ' to nearest lot <br /> Num6or �� p��. ���g m*to,�| ���m��^ Size: D�m�+u,. «« Dapt� ��� ^ ---'- � � » <br /> �~ -------' ''~~^^^�^~~- ' �--- ���u�- ----------------- <br /> Cesspool: Distance from nearest wn|L----------------Distance from foundation-------------------Lining muh,rioL-''_--_.''-_-.-- <br /> [] Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------ ---�/ <br /> Privy' Distance from nearest well Distance from nearest building <br /> Remodeling and/or repairing (describe): --- <br /> 4A� --------------- <br /> I hereby certify that I have prepared is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, StqU4@ws, and rules and r u flons of the San Joaquin Lo I Health District. <br /> (Signed) A--- --------- <br /> (Plot plan, showing siz 1 0 1,+, location of system in relation to well , buildings, etc., can be plac on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- --W------j/------1\4---—------------------------------------- DAT1E_____4 <br /> REVIEWED BY I <br /> ---_--��------_._------_--------------'_--' ----_-_---------.------_-._---'_--.-_. <br /> HMAL INSPECTION BY: -''KI V '—'''-'-_'' Date-------- '' 1~~-''-''---'''_-.' <br /> SANJOAQ0NLOCALHEALTHD|STR|CT <br /> /m sv"* American Street 300 West Oak Sf,ee* /oo Sycamore Sheaxw w"+h 'vr' s+=° <br /> Sto"*"". o°|»="ia Lodi, California w=+""°. C°|ao,"ia Tracy, California <br /> Es-9-- w o'a/ Revised w-2/00 / <br />