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G <br /> .1`yLICATION FOR SANITATION �,T r,1 Per No. .,�Z-.�•,-`_ <br /> - ----- -- ---- .-- (Complete-In Duplicate) <br /> This Permit Ex ires 1 Year From Date Issued UUU fe Issued _......... (c, <br />! /'pplication is hereby made to the San Joaquin Local Health District for a permit to construct ai <br /> This application is made in compliance with County Ordinance No. 549, nd in the work herein described• <br /> JOB ADDRESS AND LOCATION..1.4".7!0/ E <br /> Owner'sm __.-•-- .-.-.----- - <br /> Address...... 7EP <br /> ----------- -------- Phone. - �/(c?—?? �Y' <br /> - <br /> Co.�rractor's Name.__ � -_-. ---------------------•- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Phone...... he.r............................ <br /> Number of livingunits: .- ❑ Motel ❑. Other ❑ <br /> L-- Number of bedrooms --Of__ Number of baths. <br /> �.-. Lot size __-- <br /> Water Supply: Public system ❑ Community system ❑ .. .. <br /> C]Character of soil to a depth of 3 feet- Sand Gravel �1Sandy vate Depth to Water Table _... _ ft i <br /> ❑ y Loam p Clay Loam ❑ Clay ❑. Ad <br /> Previous Application Made: (If yes,date...... obe �rdpdn ❑ + <br /> ......... . j <br /> No New Construction: Yes Q' No ElFHA/VA: YesX No ❑ <br /> TYPE OF INSTALLATION,AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 �� <br /> Septic ank: Distance from nearest well..-.S"� feet.) <br /> -D�s'ance from foundation__._1.4-'. <br /> No. of corn artments..._ Y ��,'` ��. s, Mate i �.�.' ----- ---------•-. <br /> p � ...............size_ <br /> Discos Ltquld depth....... ...... ........Capacity./AGE I' <br /> Field: Distance from nearest well...'-�_--- F. <br /> -- DE�ta-:ce from foundation___-_.f-9'-- - Distance to nearest lot lines._.---_--• <br /> Number of lines---------- Ler J- of each line_ ? '.'------- ------Width of trench_..­—�--`--•._-•- . <br /> Type of f lter material.--.__Sr- <br /> ._._Ds�t., of filter material.--------1_� ---Total length_.-.._f-Sa _-.------ - <br /> Se-2 Pit: Distance to nearest well- /:Lj�' <br /> [71 Di_iance from foundation...---/jV----_._Distance to nearest lot fine,-. ....... <br /> Number o' pits--- -- ..-...__-Lining . 'S ? Size: Diameter------- .- <br /> Cess ool: -- ----Deptn...��-- <br /> P ,stance from nearest well................Distance from❑ ..-.... <br /> - - e foundation...... ..Lining materia)-_...Diameter. ---------- <br /> n--------------- - --- -- -----Liquid Capacity-...------ ....---- <br /> - - � - � --.-gals, <br /> r�''Y� Disfiance from nearest well.......................... � <br /> ....................Distance from nearest building_-._.-.--------_--.- <br /> ❑ Distance to nearest lot line ..__-_--._--- - �- --- ----.-. <br /> ---------------- ---------------------- <br /> Re^iodelir.g and/or repairing (describe):----------- --------------------- <br /> --------------------------•---- ----- -•-----•--•-•-•-----..-.._------------------------•---•----•--------•-----------------------••----- ------- .......... ----- -. <br /> ------------------------•---- •--• - ..----- --- . <br /> - ------- •------------ ......_.... <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co ` <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, unty <br /> (Signed)------- .. -- I <br /> By: <br /> (Ownei mf/or Contractor) <br /> -----------------(Tif le).-••--------- <br /> (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be placed on reverse side).. <br /> ".., FOR DEPARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED BY__-_ __.- - .--. � <br /> `--..-•*••---------•----- DATE......./-......2.3- <br /> ---&.5. <br /> REVIEWED BY....................................... <br /> ---------------------------------------- •-•-----.....-•--- <br /> Alterations and/or recommendations:___...--•---_-.- ---------------�---------•- DATE <br /> BUILDING PERMIT ISSUED.-,---------•---- <br /> ---•-------------------------•-•------ • -------•------- DA•TE---•-----•------•----- <br /> -.-....._._ <br /> -----•-.._. ................ ----- <br /> -- -------- •----•---•-----••---.... . <br /> ---- <br /> --------------------------------------------------- <br /> ............ _- 7..r. <br /> FINAL INSPECTION BY: ----_-------------------------- <br /> Date........ <br /> A..._._. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasollon Ave. <br /> 300 West Oak Street 124 Sycamore Street � <br /> Slocklon,California Lodi CaliFornia 205 West 9th Street <br /> E.H.9 2M 1-67 Vvngvtrd Press Manteca,Coli►ornia Tracy,California <br />