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FOR OFFIC & <br /> APPLICATION FOR SANITATION PERMIT / <br /> Permit No. <br /> ---------- <br />-- --------'" ------------------------- Complete in Duplicate) <br /> ( _ Date Issued <br /> This Permit Ex it m 1 Year Froin Date Issued <br /> ll the work herein described. <br /> Appltca <br /> tion is herebymade to the San Joaquin Local Health DiNoc for a permit to construct and insta <br /> This application is made in compliance with County Ordinance <br /> = • ----------•----------- <br /> •------ .JOB ADDRESS AND LOCATION---� �--0------� -1 — . . Phone. o4-- <br /> Owners Name---=�-- ------��-------••------•----------••--------------------•--.._."---•- --•----- ---- q_ .g <br /> --------------•-----------------•----•--------•---------------- <br /> S�IIII.. ------- Phone----------------------------------- <br /> CContractor's -- ❑ Trailer Court ❑ Other <br /> ontractor's Name-_--O-w��-----------•-------•-----:..---•--- ---•- Motel ❑ <br /> Installation will serve: Residence S Apartment House ❑ Grp' <br /> Number of living units:Public system ®_-1----- Number of bedrooms _E]3 ❑ P_-- Number f }h to WateoTalble �'�- f}, <br /> Community system Private 4 <br /> Water Supply: Y ❑l rave <br /> G ❑ [I5andy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan <br /> Character of soil to a depth of 3 feet: Sand ❑ New Construction: Yes 41 No ❑ FHA/VA: Yes ❑ No 59 <br /> Previous Application Made: (If yes,date-------- <br /> ---1 No [ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' <br /> Distance from nearest well.-)A-6A Distance from foundation._"_-lQ.-..-----.Material---yc-.��'''Q•Q <br /> Ca acct QO___ <br /> Septic Tank: P y { <br /> No. of compartments--------�- ----- ----Size"3_xS_-.-1X_q_•---•--.Liquid dept -------- ---- - --- -- - <br /> �-¢-`------------------ <br /> is osal Field: Distance from nearest well__V-ciH_6----Distance from h 1 n � -�0� __...V+/dthcof#tre chest lot line._- .-.----•- <br /> D P Length of <br /> ® Number of lines-----�---------- ------- g +� Total length -------• <br /> Type of filter material.--xsa Q. ---------Depth of filter material------ g 0 <br /> Seepage Pit: <br /> Distance to nearest well----KQ��------Distance fromfoundation Size: Dia��t4DIx Go 8.fio Depthst lot...ine_ -S1-_- <br /> ® Number of pits------- ---- -------Lining material_"__frs7 <br /> ---------------- ian -- -- ---Liquid Capacity--- ------•---------.------gals. ' <br /> Cesspool: Distance from nearest well---""__-_--"--.._Distance from foundation-""_-__-"__-"_-- --.Lining material-.--"---"_"-_-----_--"- <br /> ❑ Size: Diameter-------------------- Depth --. <br /> Privy: <br /> Distance from nearest well----------------------- ---------- Distance from nearest building <br /> Distance to nearest of ine--_-"----"-------------- <br /> ------------------- -- ---- <br /> Remodeling and/or repairing (describe):-"______________"_"---"_- -- <br /> •--•- v� <br /> ----------------------------------------------•-------•------------------- ----------- k. <br /> - ------------------------ <br /> -' -- - --------' <br /> clo <br /> ulais ns application <br /> the San Joaquin LocalkHeawill <br /> l heDi strict. (Owner <br /> accordance with San Joaquin County <br /> I hereby certify that I have prepared <br /> ordinances, State laws, and rules and reg <br /> (Owner and/or Contractor) <br /> -------------- ----- <br /> ( 4 ) <br /> By:---------------------------- of location of system in relation to wells, buildings, etc., cat beleplaced on reverse side). " <br /> (Plot plan, showing size of lot, <br /> FOR DEPARTMENT USE ONLY <br /> DATE---- -- 1------------------------------- <br /> APPLICATION ACCEPTED BY- ----- ---- <br /> ---------- DATE------ •----•-•-•---------------------------•---------- <br /> REVIEWED BY----- ---------------- <br /> ---------------------------•---- DATE--------------------- ------ - ------- -•--- <br /> BUILDING PERMIT ISSUED----------------------------------------- ------------------------ <br /> Alterations and/or recommendations:--_ "'-- f--------L!� .... ti"­_% A "" ~" <br /> ------------ •--------••---- <br /> ---------------------------•----- <br /> kC-res ----- ---- ---- <br /> ------•------••-------------------•---------------•--- <br /> ----------------------- <br /> --- <br /> FINAL INSPECTION BY:----If---L--- ---- -------------- •- - - - <br /> ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 124 Sycamore Street 205 West 91h street <br /> 130 South American Street Manteca,California <br /> 300 West Oak Street Tracy,callfornia <br /> Stockton,California <br /> Lodi,callfornia <br /> ED-9 FEVI6ED e•59"'Co'SM 6.613 <br />