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,. APPLICATION FOR SANITATION PERMIT Permit No. .�iQ.r�l.....=. <br /> y (Complete in Duplica{e1 <br /> Data Issued ...1.3J.. <br /> Applica4;on is hereby made to the San Joaquin Local Health District for a permit to construct and install the work'herein described. <br /> Th; apptication is made in compliance with County OrdinancA No. 549. I� <br /> (� r ��� ^ . <br /> JOB ADDRESS A LOCATI N-.�.:.+...oz..1 ..... .111...1 ................. 1....111 ...... .. <br /> / c ft. <br /> OwnersNanie... .. .. 1111_ ... ....... .......................................... ... ..................... ................. Phone!.. . <br /> Address..........+ . . .................. ...Phon ... ...�..F! <br /> 1111. ..; <br /> .... e� <br /> r Contractor's Name--_.. :_u••�.�'O" 4 .{ ..r. 1111. .. ....... 4 <br /> r.2 <br /> Installation will serve: Residence &—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel © Other ❑ <br /> y Number of living units: A.... Number of bedrooms Number of baths Lot size ... �c <br /> Water Supply: Public system ❑ Community system ❑ Private -"Depth to Water Table JQ ft. j <br /> r� <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe Hardpan❑ 4 <br /> Previous Application Made: Yes ❑ No 1!5-"ew Construction: Yes ❑ No <br /> s <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: a. <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet. l ' <br /> Septic Tank: Distance from tweilDanca from foundation....................Material ....'. • ..: <br /> No. of compartments ments• ................. 1eaePt .. --. �P��ty.... <br /> . ............. � <br /> Disposal Feld: Distance from nearest well.. 0......Distance from foundation......IX...-.Distance to nearest lot ...... <br /> [ Number of lines.............. Length of each line....... .X...........-.Width of trench..l!.i�.-`.'.................... ` <br /> r <br /> Type of filter material../..-f. .....Depth of filter material...... .��-....Total length......74..1-:-..........I...... <br /> ❑ Number of pits......................Lining material....:............----.Size: Diame+er..............-........Depth e......._......... <br /> Seepage Pit: Distance to nearest well......................Distance from foundation_.•.................Distance to nearest lot tin <br /> Cesspool: Distance from nearest well.................Distance from foundation.................... material.... .:....1....................... <br /> ❑ Size: Diameter......................................Depth...................................--...............Liquid Capacity..:.._::....................gals <br /> Privy: Distance from nearest well.................................................Distance from nearest building........��............i.................... <br /> ❑ Distance to nearest lot line.......................... <br /> Fr Remodeling and/or repairing (describe):......... �� .-. .. 7 <br /> .,L 1111 _. _.__.. 1111 ........... .. ........ ... ... ..._ .................. <br /> ;{ ... ..................... ........... : <br /> y <br /> ' ............................................................... .......................--................................... , ............................ <br /> certify <br /> prepared.... ... this a rlication .- <br /> I hereby carp that i here re and that the work will be done m accordance with San Joaquin County <br /> ° ordinances.4116w , and ru and r ula{ions {he San Joagwn Local Health District.(Signed).... ... ........ .. .. ....... _. /......... ..( eC.. 11 1111 .. ..By:.. Z�C2 r.�.Lr 1._C.+ r•�.... ....... ........ _...................................-- ........................ <br /> (Plot plan, showing las of lot, location of system in rotation to wells, buildings, etc., can be placed on revere side. <br /> Ir <br /> FOR DEPARTMENT USE ONLY <br /> .l <br /> APPLICATION ACCEPTED BY. •--••......................................... DATE....:--1----•-.... _........ .........----•.... <br /> >< 1111............. <br /> �' REVIEWED 13Y.-1111. ��................�--�............ -. 1111.. <br /> 1111.--•................... ........ ......................---�--.............................................. DATE...._..`.��r '.............-....... <br /> r BUILDING PERMIT ISSUED................�.. . . <br /> ................'._......._..-•------.--••--•--1111..-.........._ <br /> DATE...................' _ . <br /> Alterations and/or recommendations ............ ...:...... :, <br /> l; :1111.. �j`-3.... •• <br /> 1 .. ................................................................ .................................................................................................. ------------------................ <br /> .............. <br /> �' i . . .`- I 1111..-......._......... ...............................................................................................................................................1111. ..-_--............_ ............ <br /> ............................................... �j <br /> . 1111-1. ...................................... --.-_--------------.----_-------:•---------__ <br /> ;t :L ii �PECTICtd BY:. Date. _. .Z.-. 5111. <br /> ..................:..... =r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT i3 <br /> w(r Ama:ieen Siraei 300 Wesf Oak $treat" 132 syeamoro st»at 014 N" "C"Striaat <br /> t::ul i,rr a Lodi, California Manteca, California Tracy, California <br /> i; I <br />