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40 <br /> f (� APPLICATION FOR ,SANITATION PERMIT Pertl+t-No. - <br /> 3' y (Complete in Duplicate) <br /> Date Issued 3.__t1_s__-- <br /> pplicatiori is hereby made to the San'Joaquin,Local Health District for a permit to construct and install the work herein described. <br /> This appfication is made in compliance with County Ordinance No. 549 <br /> JOB ADDRESS AND LOCATION_-In._San .J0_a u .��1v_er.: tib_ Qx�.__ & <37a__ c _4:__a ut. ...IQ—A1je5_,.5o . . <br /> g q �p, <br /> 2-G-16 i me bershi 22Q <br /> ,:Owner's Name .. - get J 3' y fel -int-i-i---:Tracy- --- -a-1 f-: p------- Phone 1(J6 C? T t V <br /> inttl.-ZSX<_-,JDA ,].in__RJ_Y.es_:.Q-I- Ub__�a' ___tile-Ar 2�--U -._.��.:�o... ho-'a�i�h. <br /> a. se - turn rt..:and pass first 2 rds . on rt . urra on rd. a ut bIk. <br /> on rac#ors ame.--r }e .a•. ------- -------- Phone__._.. <br /> -r3-5--_-- <br /> Installation will serve: Residence Ur] Apartment House ❑ Commercial ❑ Trailer Court ,❑ Motel ❑ Other ❑ <br /> , i of�ng units: _._1=- Number of bedrooms ___l_ Number of baths ___l_ Lot size _. _(1X1Q�?----­------.... . ..F_ <br /> Watef Supply: Pu+lic`sy'tern-❑ Community system C] .Private Ek Depth to Water Ta __ble _V ft. <br /> l:horacter at soil"to.a` Iptk of 3 fest: Sand jQ Gravel ❑ Sandy Loam❑ Clay Loam ® Clay[❑ Adobe❑ I-Iafdpan ❑.; <br /> Previous Application Made: Yes E] No [N New Construction: Yes' No ❑ <br /> TYPE:OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance fiom-nearest well._.__rj0......Distance from foundation__$R............material---aeaen:t----------------------------­ <br /> No. <br /> _„ __________ _______,''s <br /> No. of compartments•,•• � p 6_'�x4!X4'---------Liquid depth-----5 r_&3�!-------Capacity.....----8Qi,?----- <br /> Disposal Field: Distance from nearest Distance from foundation 1Q' Distance to nearest lot line ,5_...... <br /> ] kumber of lines ----------------------- <br /> Length of each line......60!................Width of trench fit.,*. . ---.-------- <br /> Type of filter material-- Depth of filter ma#�rial...........---<----<---Total length................... <br /> ------ -------- .:. ._ :. <br /> Seepage Pit: Distance to nearest well -----------------.Distance"from foundatio _____ -.Distance to nearest lot lite <br /> ❑ Number of pits ______________Lining material...._1 -----_--;_._.Siie<• iameter--_--- ------------Depth---------------------------------- <br /> Cesspool: <br /> ---_- ----_- -Cesspool: Distance from nearest well.-_-__-____-•-__Distance from foundation........: ........Lining material-_ __-:___.. ___..... ____El .___ <br /> Size- Diameter_____ ________ _-_- --�D th_:-:_-= •------__ .Liquid Capacity--------------_ ,._.._.gals. <br /> Privy: Distance from nearest well--------- ------------------------------------Distance .from nearest building-----._. _____-_, ______-............ <br /> a <br /> ❑ Distance to nearest lot line......---------------------------------------- -------- -------- ------- ------- -------- ---- -. ---­----------- <br /> Retrio, eling an or repairing (describe).......lnstall�in� x ear 2TC811 C�I11e] t-YET'iCk:_�1E3 .iL'...tank-and.. <br /> t� lfng_.bg-f .__cad._ho9..zanal--sirai3a------------------------------ --- ----- <br /> ------ ------- ------- - ----- ------- -- ------- -- - - ----- -------- ------ - - - <br /> -- ---- <br /> I hereby certify.that 1 have prepared this appircation and #hat the work will be don in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the,San Joaquin Health Di` • <br /> Sined----------------------_A a ------ - --- - <br /> BY-----------------------------------Ferrv._Aar t b -- -- --- ----el� isle)....0x �x'.4Zr•----------------------------- <br /> (Plot plan showing size of lot, location of system re anon s, build' gs, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY....................-- --•------- ---- ------- --- ----:_ DATE •. <br /> REVIEWED BY............................ - ---- ----- -------- DATE DATE- ----------- ...... = <br /> BUILDING PERMIT ISSUED............-=-- --------- -•---• ---• - DATE. <br /> ------------- <br /> Alterations and/or recommendations:..........................- -------•-----.................................-----------------........................................................:.._.. <br /> FINAL INSPECTIONBY:. --- 4 r Date.. - ,.. C.�.•�- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 134 South American Street 300 West Oak Street 132 Sycanwe Street 814 North "C"-Street <br /> Stockton, California Lodi, California Manteca, California Trady. California <br /> ES-9-2M 8-51 Revised W-2100 4 <br />