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22222! <br /> APPLICATION FOR 'SANITATION PERMIT <br /> Permit N <br /> 4f omplete in Duplicate) Date issued <br /> her,,, described. <br /> Application is hereby made to the San' Joaquin Local Health District for a permit to construct and install the work <br /> This application is made in compliance with County Ordinance No. <br /> S9. <br /> j --- -----------------------------------------------------------------------/ <br /> JOB ADDRESS AIjD,L tATION---- _,j ------------------------- Phone-3----- <br /> . . .....------ <br /> Owner's Name-,--- ----- ----- --- ------- --------------- ---------------------------- -­--------------- <br /> --- --- -------- ------------------------------------------------------------------ ----------------------- <br /> -------- ------------ <br /> Address----- ---- ----- -------V-------- --------------------------------------------------------------------------------------------- Phone <br /> - ---------------- Motel [I Other <br /> Contractor's Name---- .Re-s.i-den______•c e------ Apartment House [I Commercial El Trailer Court L --- P------------------ <br /> Installation will serve: at j_ e ----ff <br /> Number of living units: -37. Number of bedrooms Number�qeb h --- Lot size e -------- ft- <br /> Community system 0 Private K D,ptb to Water Table <br /> Water Supply: Public System / Gravel Sandy Loam / Clay Loam 0 Clay ❑ Adobe 3"--Hrdpan [I <br /> Character of soil to a depth of 3 feet: San 9n D �p I <br /> ation Made: Yes 171. No F�T New Construction: Yes �T No 0 <br /> Previous App <br /> lic AND-SPECIFICATION <br /> TYPE OF INSTALLATION beh0feet.)0 septic tank or cesspool permitted if public seweris deaf <br /> aterial_---------------------------------------------- <br /> JN Distance from n,arest well-----------------Distanrom foundatio0-feet.) <br /> n- dept-h -M---------------------Capacity---------------------- <br /> Septic Tpnk' Size---------------------------- Liquid <br /> I <br /> No. of compartments__------------------------- -------------------Distance to nearest lot line----------------- <br /> Distance from nearest well------------------Distance from foundation idth of trench_-------------.al pi6w. ------------------------------W <br /> Dj'spo <br /> Number of lines--•--------------------------------Length of each line ------------------------------ X <br /> Ty e of filter material----------------------F Depfh�of filter I material-------------------•---Total rim length lot lin <br /> P tion---- ---P <br /> ---------D <br /> dation---_.__-- �qtance t? nearest 0 <br /> irest well.----1-0-0----Distant roe fou ez) X/_0____.Depth----------- ----------------- <br /> - Z - Diameter_ ---------- <br /> Distance to ne� U0A <br /> Serpa Number of pits----------24------Lining material. -"re.110; ------------------------------­_.___---- <br /> ce from foundation--------------------Lining material ---' ' - -gals <br /> . I_ <br /> nearest well------------------Distan Ca _----------------------:--ga s. <br /> Distance from, __1-----------Depth----------- --------------------------------Liquid C acity <br /> 0 Size: Diameter---------------------------------------- Distance from nearest building----------------------------------------- <br /> Distance from nearest well_------------------------------------------------- ----------------------------------------- <br /> Privy: Distance to n4rest lot Zine-------------------------- <br /> ­-------------------------------------------- <br /> 17-1 ,I ------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (desIcribe)-------------------------------------------------------------------------------...-----___-•- <br /> -----•---------- I-------------------I----------------- <br /> ----------------------------------------------------------------- - -------- ------------------------- --------------------------------- <br /> -­----­ <br /> ----------- <br /> --------------------- ------------------------ ----- -------------------- <br /> ------------ <br /> ------------------------------------- ----------- -------- ---------------------------------------- -------------------- <br /> ------------------------------------------------------------------------------------------------------------I that-_the work will be done in accordance with San Joaquin County <br /> I hereby certify that 1 have,lirepared this application and <br /> P s of the San Joaquin Local Health District. <br /> ordinances, Stat laws, and rules and regulation Contractor) <br /> T --------------------------------------------(Owner and/or C <br /> x -,- , ------------ <br /> - -------- --- ---------------------------- <br /> (Signed)-------- (Title)---------------------------- <br /> By:--------------------------------------- I relation to wells, buildings, etc., can be placed on reverse side) <br /> (plot plan, showing size of lot, location of system in <br /> FOR DEPARTMENT USE ONLY <br /> %LS1% <br /> ----------------- <br /> -—————————— DATE- -------------------------------------- <br /> -------------------------------------------------------------- dr- ------------------------------------------- <br /> ,CCEPTE --- ------ ------------------- ------ --- --- <br /> APPLICATION ACCEPTED -------------------------------------------------------------- DATE <br /> -_ - - DATE--------- ------------------------------------------- <br /> REVIEWEDBy------------------------------ ------------------ I <br /> I., -------------------------------------------------------------••-------- <br /> ,BUILDING PERMIT ISSUED-------!�---------------------------------------- --- -- ----- <br /> mmendations:------------------------- -----C ------------------ <br /> Alterations and/or ret p Z4,.j --- --- <br /> _n�..... W_ <br /> -- ------ -------- <br /> ----------------- ------- <br /> -- ------ A—A ----- <br /> ------------------------------------ <br /> ------------ ---------- ------------------ <br /> ----------------- --------- -- ------------------------------ <br /> ------------ ------------------------------------------------------------ ----------------------- ----------------------- --------w--------------------------- <br /> ----------------------_----------------------- <br /> --------------------------- -------- ---------------------------------------------------------------- 6— S- ------------- <br /> IDate -----------------------------------—- ------------------- <br /> FINAL INSPECTION BY -------•---------------------------------- -------- <br /> LOCAL HEALTH DISTRICT <br /> 814 North "C" Street <br /> SAN JOAQUIN <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street Tracy, California <br /> Stockton, California Lodi, California Manteca, California <br /> E5-9-2M 8-51 Revised W-2100 <br />