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' APPLICATION FOR SANITATION PERMIT Permit No. <br /> y ' <br /> (Complete in DuoUcofo <br />. ' ' D�h, |eme6 <br /> | <br /> Application is hereby made to the San Joaquin Locu Health District for a permit to construct and install the work herein described.This application is made in compliance with Count)( Ordinance No. 549. , <br />� J{}8 ADDRESS AN <br />� -- --------- <br /> '' ' l <br /> (]wner� Name------------------- ~~-----'-_-------�~~`-�^' --------------------------------------- rnone / <br /> Address_-----___-.-__�----'--' --'-'------'--�-----'--'-----'-------------------'''--- ' <br /> ctor' W* <br /> Installation will serve: Residence <br />� -- ` E Commercial E Trailer_ ~-... �] .,.~.~. 7 Other <br /> Number of living units.- _/---- Number of bedrooms ---/___ Number of baths <br /> Water Supply. Public system ��_�Ommlnify system -E] private E] Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of-3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay 0 Adobe <br /> _~___ pan -- <br /> Previous Application Made: Yes E] No Q_._-New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sepfic Tank: Disfance'from nearest from foundation-------/4__t�__.Materi I <br /> Dl�sp�osa� Field: Dis�ance from nearest,'welle��6,�Dlasfance from f*c'unclat' /- ------Distance to nearest lot line--.6,77 <br /> Type of filter material---�r,_r,__ASdVepfh of filter material---- -------Total length---------�/o <br /> Seepage Pit: Distance to nearest well------------------- -Distance from foundation-----------.-...--..Distance to nearesf lot line----------------- <br /> ___r-_. Distance from "ea."^. well-----------------Distance from foundation--------------------Lining mutahaL--_--_-''___._ <br /> LlSize: Diameter _-----__ ------Depth----------------------------------------------------Liquid Capacity---------------------------- <br /> Privy: Distance from nearest well ----'---''--'' --------------Distance from nearest building--_.--.__ <br /> E] Di�anu, tunenre� lot line <br /> -- <br /> Remodeling and/or repairing (describe):----�--_--''-_--__-___-----____-,_____--__-_______._____.___ <br /> --------------'___' ----------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- � <br /> '__'------__.''-__-'_-__.__-___-'___.'--__-___-'-_-____.—___--._--.__.__..__._-- . � <br /> . __-_ <br /> ___________________-_________'______________'____'____'______'___�____________________ <br /> | hereby certify that I have prep6redthio application and that the work will 66 done in accordance with San Joaquin County <br /> ordinances, State laws,' and rules and regulations of the San Joaquin Local Health District.(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y----- ''-'-_ --------------------------------------------------- DATE-.. ' ` <br /> REVIEWED BY-.__.----._--'—�--''~-------------�------�-- '—°'— -----------------'-«� ------''--'' ` <br /> BUILDING PERMIT ISSUED_-_-'_-.-_.''---�''-_---__'-_.'--_-''--_'-_ DATE <br /> Alterations <br /> AKo,u+ionsand/or recommendations:----._---__.-_----_-_--__.-__._-__-----..__----' �_---' <br /> -''--' <br /> �������'_���'_����_��__���__����__����_���____��____���___���___��__��___��'___���'__��� ------'---------'' <br /> ------------------- --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ------- <br /> ----------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- <br /> . ^ <br /> '-�'-''----''--'�--.''__'''------'''_-''''_''''-_.'----'''---'''-_.'''-'-'-_-''----'---'-_-'-----'-- ` <br /> FINAL INSPECTION BY:------------------------------------------------------------------ Dax:''---�- <br /> / <br /> SANJOAQU|N LOCAL HEALTH DISTRICT / <br /> mo South Amo,u"" Street 300 West Oak Street /xc Sycamore Street mw mm+h "C" Street <br /> S*""kt"". C"|av,n;a Lodi. California <br /> Manteca, California Tracy, California � <br /> Es--9-2w o's| Revised vv-2/00 � ~ � <br />