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FOR OFFICE USE; <br /> ........... <br /> Permit No. <br /> APPLICATION FOP, SANITATION PERMIT <br /> ............. <br /> (Complete in Duplicate} Date issued <br /> ......j This Permit'Expires I Year From Date Issued <br /> n <br /> Appiica�fion is hereby made to the San Joaquin Lotal Health District for a permit to construct and 'ns+ajI the work herein descrImed. <br /> This application is made in compliance ith 00 <br /> .�­&'q/j,CE 4 <br /> Cou�ty Ordinance No. 549. <br /> j <br /> �. � ...... <br /> ....................: <br /> JOB"ADDRESS AND LOCATION. . <br /> owne "N eA <br /> e <br /> 0 <br /> Addres$_..., <br /> Phone...... <br /> Contractor's Name..... .............. ....... ....................... ............................... <br /> Tra <br /> installation will serve: Residence Apartment C]Commercial I iler Court 0 Motel 0 <br /> Number of livinunits: : ... Number of bedrooms Number o "Oths size <br /> g <br /> ft. <br /> Water Supp Publid stern Cornr�unity sysi,em, 0 Pr v to El'-Depth h to Water Table <br /> Supply: sy Gravel [3 Sandy Loa I m 0 Clay Loam[3 Clay C] Adobe CI Hardpan <br /> Charactersoil <br /> oj. to a depth of 3 feet: .Sohd.n <br /> No r—i <br /> I If yes,dole.._r :�...........,;1 No New Construction: Yes D No C-1 FHA/VA: <br /> Previous Application Made: <br /> 4.�-ftt <br /> TYPE OVINSTALLATION-AND-SPECIFICATIONS: " <br /> (No septic t ank!or cesspool permitted if public sewe Zt, <br /> . is available within 200 U09 <br /> r I 1 1 ..Materiai... <br /> Septic Tank: Distance fromnearest we .......Distance from foundation_....:`__.._.._,. ._..,. . <br /> Capacsty�.......... <br /> ................. ........... <br /> No. o ornpartmenis........ <br /> f from foundation�...............­Distance to nearest lot line-.--------- <br /> Disposal Field:, Distance-from nearest-well.............../Distance .Width of <br /> Cl Number of lines.-I Cength of each line_...................... <br /> ......Total length......................... <br /> Type of filter :Dept� of filter <br /> Seaga Pit: <br /> Distance to nearest well._1010 __Distarite f d <br /> '__...Djsta,ce�o neare <br /> st lo <br /> t line_g....... <br /> Size;`Diameter_._._. . Depfn...... <br /> lumber of pits . A.,.-.I........Lining material..... <br /> from 10"undation,_ ...... Lining <br /> Djstnncn f�om nearest wail.. ......... Distance-- _,»-»----------1-40S. <br /> Cesspool: Liquid Capacity <br /> Depth_ ........ <br /> Size: D"8n)etC1*­­........... ...... <br /> .......Distance iror-, nearest,building ....... <br /> Privy: Dlitance frorn'rieCreSf \;j]l_ ...... .... ............ <br /> ............................................ <br /> Distance to noare,,t lot line.......- <br /> Remodeling <br /> .......................... <br /> . <br /> Sm s F z7e ..... ..7.1............. ... .............. <br /> 10 , .............. . <br /> 4�K4 <br /> ..........I-------.... ............... _-.•.._...._....... ..........................—....... <br /> A&�.i,. -.v,.-- ­rl��rl�__ I­.... ­I.-... ,I. I I--­'­j.­­�,�_... ­ . <br /> x... ......I........ ....................... <br /> ............... d 4h.t the work will be done in accordance with San Joaquin County <br /> prepared this application an <br /> I hereby certify that ave <br /> 'ordinances. Sta laws, and rules and regulations of the San Joaquin Local Health District. <br /> d/or Contractor) <br /> ................... <br /> (Si9n.11..__., .......... <br /> .................. <br /> By_ ............... ......... ..... .... <br /> , owing <br /> Cato 'of sysfJ� ells, buildings, etc., can be placed on reverse side)- <br /> (Plot plan. s owing size of lot, location in relation to w <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By.._ ...... <br /> DATE_........ ................ <br /> RF41EWED BY.. ............ <br /> ............___..... . ............. <br /> BUILDING PERMIT ISSUED___....................................... - ----- <br /> ................. <br /> Alterations and/or recommendations.............................. ........__­.............................. ....... <br /> I ...........­­,_......................... <br /> ................ <br /> ..... ........... ...... .......... <br /> . «..»..,,_.k... <br /> .......... ..... »..--._»««...._•...................« <br /> ....................... • <br /> ...... <br /> .......•»...«...................................... I ­............. ...................................................­.........—1....................... <br /> ..«......._. <br /> ........................ ............................................. . - .«»......__..,..«.I __.-.____.._...........«.».«»» <br /> I ......... ............................ <br /> .........................................................«.»........, <br /> ............. ......................................­....«.._._................... <br /> Date.... s�......... ....._,»,.....»,..«.«« <br /> FINAL INSPECTION BY:..._.. 5�&4� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 16ol 1.Haxelwn Ave. 300 West Oak sitboo 124 Sycamore Street 205 West 9Ph Street <br /> st*cktan,califeenjo Lodi,California Manteca,California Tracy,califorimic <br />