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Permit No. f,7 <br /> N PERMIT -------- <br /> APPLICATION FOR SANiTATIO <br /> V <br /> Complete in Duplicate) Dafe Issued <br /> iASan joagvin-L-ec-at-Health-Dist-r-ict-f�or..p permit to construct and install the work herein described. <br /> Application is hereby made to the Cou n�ity� <br /> This application is made in ompliance w, o. 549 <br /> ------------------------------ ------ <br /> ----------- <br /> ---------------- <br /> JOB ADDRESS AND LOCATION ------ <br /> Phone-----7-7 <br /> . ...... ......... ................ <br /> Owner's Name----------------------- -------------- ------------ <br /> -------------------------------------------- <br /> ------------ -- <br /> Address------------------------------------------------------------- <br /> Phone-. 6--0---;7. <br /> Contractor's Name-------------------- <br /> Installation will serve: ill 5< Apartmer Commercial Fj Trailer Court 0 Motel Other [3 <br /> if House [I <br /> ------------------------- <br /> Number of li' ing units: 1---- Number of bedrooms -c;-- Number of baths Lot size <br /> iLm F-l Community system 'El Private 0 Depth to Water Tab�ll�__ . ff. <br /> Water Supply: Public syst Hardpan F <br /> 1� D Clay'D Aclobe4 <br /> feet: Sand 0 Gravel [I Sandy Loam F1 Clay LoA_m <br /> Character of soil to a depth of 3 ___1 , -- <br /> 11 0 <br /> Previous Application Made- Yes [] Noj�!(_New Construction: Yes Ej N oc�>- ��6,L-.4 <br /> TYPE OF INSTALLATION I'AND SPECIFICATIONS: available within 200 feet.) <br /> ( o septic tank or -I IJ esspooi permitted if public sewer is ce from foundation--------------------Material------------------------------------------------ <br /> epfic Tank- D i stance from nearest well-----------------Distan <br /> Tank I Si7e--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> No. o)compartments------------ nearest lot line------L----------- <br /> Distance from nearest well------------------Distance from foundation--------------------Distance to <br /> sa Fi . -. 1� --h-11ne Width of french--------L-------------------------- <br /> Number of lines-----------------------------------Length of ea< <br /> ---- ---- Do'" �_;;�brial--------------------Total length---------------------------------------- <br /> �o�o 'filter <br /> Type 'of filter material---------- ------------ I-- f . nearest]o+-We_,/ <br /> *�qd fiom ----- ----------- i, aace o <br /> P <br /> See Pit: D'�slanlcle to nearest well- ------------ ----Dista&o Depth.=;[ -------r-------- <br /> ize: Di efer--- - ----- <br /> Num0er o� pits------ <br /> Lin' g materi <br /> -------------------------------- <br /> material <br /> est we�l------ ---------:-Distance from fou' ;on. <br /> Cesspool: Distance from near <br /> I -Liquid Capacity----------------------------gals. <br /> Size: Diameter---------------------------------- e f ........------------- <br /> 11 11 earesf building----------------------------------------- <br /> Privy: Disfance from nearest well----------------------- ------------------------Distance from n -------------------------------------------------------- <br /> E] D isfi,ce to nearest lot 1�ne-------------------------------------- ------------------------------------------------ 1. <br /> --------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-----------L-------------------------------------------------------- ---------------------------------------- <br /> I ............ <br /> -----------------------11-------------------------------------I---------------------------------------- --------------------L------------------:-------- ---------------- <br /> -------------- -----------------------------------L------------------------------------------------------------------------------------ <br /> --------------------------------------------11------------------------- ---------------- ---------------------------------------------------------------------I----------------------------------------- <br /> ------ ------ --- <br /> ---------------------------- ---------I(-------------------------------------------I-----tion-_and-_that the work will be done in accordance with San Joaquin County <br /> I hereby cer�;fy thai� I av predpared thi app ica <br /> ordinanc'es, laws, a, rule an regulat ns of the San Joaquin Local Health District. <br /> Qer� C Contractor) <br /> ------------------ <br /> se Si <br /> (Signed)_---- ----------- --- ------ ----------------------------- -------- ------- 7e— <br /> ILL �_ ___ ffitle <br /> By:------- ------ .... system---in---rel-a--f-io-n----t o-----w--e--11 s--, I-d- I reee doo n v e e). <br /> (Plot plan. sho ng size ��f lot, Iocafio,n,_o`_ ings, etc., can be <br /> V FOR DEPARTMENT USE ONLY <br /> DATE_--------------------- ------------------------------ <br /> ------------- DATE----' ------------------ <br /> APPLICATION ACCEPTED BY. <br /> REVIEWEDBY---------------- ------------------^ ----------- DATE--/-------/------------------------------------------- <br /> BUILDING PERMIT ISSUED------------ <br /> 1� ----------------------------­-------------------------------------- <br /> Alterations and/or recommendations:--------------------------------------------- ----------------------------------------- <br /> 11 ------------------------------------------------------------------ -----------L-------------------------------------------------------------------------------------------------- <br /> ---------------------------------------!I. ------------------------------------------------------------L--------­----------L---------------------­--------------------------------------- <br /> ----------I--------------------------------------------------------- ------- <br /> I( ....................... ---------- -------------------------------------------------------------------------------------------- <br /> ...................-----------L-- -----------------L-------------------I---------- -----------------------------------------------------------------L--------- <br /> ------------------- --------- --------------- -------------- ---------------------------------- --------------------------- <br /> ----------L------------�­-------------------- <br /> Date---------;77�1 <br /> ---- ------ -L-------- <br /> FINAL INSPECTION <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street <br /> 130 South American ),TrceT 30D W e L st Oak Street 132 Sycamore Street Tracy,,California <br /> I a <br /> Stockton, California Locl, California Manteca, Californ' <br /> FS-9-2M B-51 Revised I�W_2 1 GO <br />