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JAICATION FOR SANITATION &RMIT Permit <br /> ---------- <br /> (Complete in Duplicate) Date Issued _X.,141-5) <br /> Application is hereby Made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> sis application is made in compliance with County Ordinance No. 549.' <br /> C T11 -- -------- . ...... <br /> DRESS A N--------------3 <br /> JOB ADI V <br /> -17 <br /> Owner's Name____-- - ----- ---- - ------ ----- ---------------- Phon <br /> - ------ ----- <br /> ----------- <br /> Address--- -- - ----- ---- ---- ---------------------------------------------------------------Phone <br /> Contractor's Name- ---- --- -------------- - ------ --------------- --------------- --------------------------------- <br /> Installation will serve: Residence Apartment House F1 Commercial E] Trailer Court El Motel Other El <br /> Number of living units-- -------- Number of bedrooms ---------Number of baths -------- Lot size -------- --------------- ----------- <br /> Water Supply: Public system E] Community system D Private;< Depth to Wafer Table, ft. <br /> Character of soil to a depth of 3 feet: Sand [I Gravel El Sandy Loam El Clay Loam 0 Clay El Adobe)( Hardpan [] <br /> Previous Application Made: Yes E] Nok New Construction: Yesx No 1_] <br /> 401— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tankor cesspool permitted if public sewer is available within 200 feet.) <br /> Tank: Distance from nearest well________________Distance from foundation—F__= -------------Material_. <br /> Sept-epT <br /> No. of compartments-------------- ------- ---Size--------------------------------Liquici depth-- -------------- --------CdOcitY---------------------- <br /> est lot line��-------------- <br /> 4Dispo Field: Distance from nearest well------------------Distance from foundation-----------------_Distance to near <br /> Number of lines------------------------ ----------Length of each line------------.------------- ----------------------------------- <br /> 'i's 0 ---.--Width of trench <br /> erial ---Deptk of filter material-----------------------Total length___.________________.-___________.____,-' <br /> ength-------------------------------- <br /> Type o I f filter mat ---------------- ne- <br /> om undafion- ---------------Distance to nearest lot, <br /> Se age Pit: Distance to nearest well-_Z/------Distance from <br /> 0!iDepth_-.- ----� <br /> C 9 --- ---- -.5?5 --------------------- <br /> ------Size --- <br /> Number of pits.---c;--------------Lining material Diamefe , <br /> c� �wmaterial_____._____---____.___._____.______. <br /> -om nearest well-----------------Distance from foundation----- -------------rLininq <br /> e�spool: Distance from <br /> 171 Size: Diameter----- --------------------------------Depth--------------------------------------- ------------------------gals. <br /> ---- ---77---Liquid Capacity <br /> 7 L Privy: Distance from nearest well___________________________ ------Distance from nearest building_____.___._--_________------------------. <br /> ------------------- <br /> ElDistance to nearest lot line______________-------------------- ----- ----------------------------- ----------------------------------------------- I <br /> -0 -------------------------- <br /> Remod ling and/or repairi describe):_- -------- <br /> C, and/or <br /> ----------- - --------------------- - ------ ------------------------- - K------------- --- <br /> ­4_z,�---------------------- --- ---------- ------- - --------- - <br /> ... ------------------ ---------------------------- -------------- ---------- ------ ----------------------- ----------------------- --------- <br /> ---- ------------------- <br /> . . ----?.6r:-�—, work will be nein accord ce with San quip County <br /> I hereby certify that I av prepay this applicatio and $ <br /> ordinances S ate laws and rules nd egulation of th an J again Local Health District. <br /> n anContractor) <br /> [Signed]---- ---- -- ---- --------- ------- ------------------------- -------- <br /> By%I---------------------- -- --- - -------------------------------------------------------------------- ---------------- - <br /> - <br /> (Plot plan, showing size f lot ocation of system in.relafion to wells, buildings, etc., can be paced on eve side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE---- ------------------- ----------- <br /> REVIEWED <br /> ACCEPTED BY------------------------ ----------- ---------------------------------------------------------- P <br /> DATE----_ --;-* __ - <br /> -- --- ---------­­------------------------------------------- -- ----I--- ------------------ <br /> REVIEWEDBY---------------------------------- TE----- ------ ------- ------ <br /> ---­---------- -- ---------------- <br /> BUILDING PERMIT ISSUED- __I I <br /> ---------- ------- <br /> "a'hd/or r cominendafio' <br /> A[ rations <br /> ----------- <br /> --- ---- ----------------- - ------------------------ - --- ----------------- <br /> --------------........ ------------------ ---- <br /> ----------- ....... ------------------- ----------- ---- -- --/./--- -------------- -------- -------- <br /> --- --- ---- --- <br /> ------( --------------------- <br /> PINAL INSPECTION --------�\,--------------- ----- Date_.---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> marican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South Manteca. California Tracy. California <br /> Sfock+on, California Lodi, California <br /> E5-9-2M 10-52 Revised W-2100 <br />