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v <br /> Permit No ./---------1- <br /> ---- <br /> b__ APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issue <br /> pli I cation is hereby made to the Son Joaquin Loca4 Health District for a permit to construct and install the work herein described. <br /> P ri,( Ourjfy Ord'n npe No. 549. <br /> This application is made in compliance with C <br /> ----------- <br /> JOB ADDRESS AN JD ATION________________,. ------ ------ <br /> I c t _ Phone--- ---- <br /> ---------------------- - ---------- <br /> Owner's Name_---___]�- -- ----- -- ------ ------- -------------------------------------------------------------------------------------------------------------- <br /> -------- ---- <br /> Address------------ - ---- --- --- <br /> Contractor's Name__--------- ------------- -------------------------------------------------------­---------- ---------------- ----------------- Phone----------------------------------- <br /> Ouse 0 Commercial ��iler Court ❑ otel 0 0 her El <br /> C, <br /> Installation will serve: Residence El Apartment H .11-11-0 <br /> Number De <br /> aths --- Lot size ----- -- -------- ------------------ <br /> Number of living units- - Mumber of bedrooms -------- Nu to Water Table -------- ft.Wafer Supply: Public system WC,ommunity-systern E] Private 0 th Adobe 0- Haclpan El <br /> Gravel 0 Sandy Loam 0, Clay Loam ❑El Clay E] <br /> Character of soil to a depth of 3 feet: San�4 Yes [[ No Ei <br /> Previous'kpoi-cation Made: Yes E] No [5 New Construction: <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> permitf d if ubli er is available within 200 feet.), <br /> ic S�x <br /> (No septic tank or cesspool --------- <br /> -�o---------- <br /> A40 ance from foundation---1:0......... <br /> Septic Tank: Distance from nearest well--- <br /> --------Nbist juid depth----------------- --------Capacity----_ ]- - -- <br /> No. <br /> -------CdPacitY----- <br /> No. of cor-.partmenis;?4-,Jv.;viitoA.esilI-----•--------------I-----------Li< <br /> �ist6nce-to nearest lot line <br /> Distance from nearest we ----- - Oistance from foundation_jg__�___*____. ch------ <br /> Dis I Field: -------- --Length of each line_________..__ 0_11--Width 8f.tren <br /> P96 Number of lines ----Total leagth------------ ------------ <br /> Type of filter maferi -------- of filter materia� <br /> lot line__.._.___-___..__ <br /> rest well----------------------Distance from foundation__-_.-_----____---.-Distance to nearest <br /> Seepage Pit: Distance to nearest h--! -------- <br /> Siz6- Diameter_____---------- ---------Dept --------------------- <br /> Number of pits----------------------Lining material------------------------, -i- f ­, I <br /> OM nearest I well-----------------Distance from foundation---_______ Lining materiae-' ------------I--------- <br /> ❑Cesspool: Distance fl- 'Liquid Capacity.....!-.-------------------gals. <br /> Size: Diameter_____________ ------Depth--------------------------------------------------- <br /> El : Distance from nearest build ing---------------- <br /> Distance from nearest well---------------------------- <br /> F1 01 1 1 11 <br /> Privy: Distance to nearest lot line._._"_._---------------------------------- - ---------- ----------------- ---------- ----- -- ------- <br /> ------ ----------------- <br /> ----------------- <br /> RXodd;n pain -- -------------------- <br /> g and/or re nq (cleb('-rib, --— --- ----------------- -z ik�)V___f_ <br /> il---- - ------- <br /> Z <br /> ------- ----- ------------------------------------------------ <br /> G__A ---------------------------------------------------------- -----------------i--------------- <br /> -------- --------I------------------------------------------------------------ --------------------------m--------------------------------------------------------------- <br /> --- ------- ------ ­­--- - ------ <br /> ----- --- ------ -- ----- ----- <br /> --- <br /> --------I hereby---__certify-- __that I__have..prepared- . - i '-­application-- -- - _and that-the- - __work-will done in!accordance with San Joaquin County <br /> a I have I an" Tha i <br /> u n <br /> Local <br /> a <br /> � ate laws, an rules and regul ions of +he San Joaquin Local Health District. <br /> ordinances <br /> ---------- ---_--;------------------(Owner and/or Contractor) <br /> -- -- ------ -------- ---------------- ----- ---------------------------- <br /> •--- <br /> -------------I------------- <br /> 5i ned <br /> -- -------------- ----------------------------------------------- <br /> ----- -------- <br /> ---- ---- ------------------(Title)--------- ------------------------------------------------------ <br /> is <br /> ------------------- --- buildings, <br /> ---- ----- ----- ---------------------- ---------------------------------- <br /> By%----------------------- ---------- ----------- It I verse side). <br /> system <br /> a .0 , wcan be placed on re <br /> 10 10ati 'Y' m in're n e <br /> e <br /> (plot plan. showing ;-Z' of lot, location f system in,relation to wells, buildings. etc., <br /> "Z r <br /> FOR DEPARTMENT USE ONLY <br /> DATE_--------------------- ---------------------------- <br /> APPLICATION ACCEPTED BY-- --- ----------------------------------------- --------------------------- DATE —---------------------------:--------------------- <br /> REVIEWEDBY------------------------------- --- ---- ------- ------------------------------------------------------------------------ ATE--------— <br /> BUILDING PERMIT ISSUED--------------- -------------------------------------------------------•-------•------------ <br /> Alterations and/or recommendations:------------------- --------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- -------------I----------------------------------------------------------­---------­------------------- <br /> ---------------------------- ------------------------ I------- --------------------------------------------------------------- ---------------------------------------------------------------I---- <br /> ------------------------------ -------------- --------- -------- ------ --- ----------------- <br /> ------------------------------------ -------------;-------------------------------- -------- ----------------------------------------------------------------------- ------------ --------------------- <br /> ----- --------------------- -------- ----------------------------------------------------------------------------------------- ------------------ ------------------------------------------------------- <br /> 6--- --- <br /> ---------- ----------------------------- <br /> FINAL INSPECTION BY:----------------- A <br /> Date----- -------- --- - ----- <br /> --- ------------I----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 13o South American Street Lodi, California Manteca, California Tracy, California <br /> Stockton, California <br /> ES-9-2M io-52 Revised W-2100 <br />