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,Vi, "It APPLICATION FOR SANITATION PERMIT Permit No. <br /> 1 (Complete in Duplicate) Date Issued <br /> 1110 Application is hereby made to the San Joaquin Local Health District for a permit to consfru arm <br /> the install the work herein described. <br /> This application is made in compliance wit ount Ordinan No 549. <br /> JOB ADDRESS AND LOCATI N-_-____.----- ------ <br /> Owner's Name------ <br /> ---- ---- - ---- ------- --- -_ Phone---------- ------ ----------- <br /> Address-------------- - ---- ----- -------- - ------------------------- -------- <br /> . ..... hone <br /> *a Contractor's Na e-------- <br /> Installation will serve. Residence El Apartment House E] Commercial [j Trailer Court E] Motel E] Other <br /> Number of living units: ....___ Number of bedrooms ---- --- Number of the Z ---- <br /> Lot size -------- <br /> Water Supply: Public system [I Community system 0 Private epth to Water Table t. -------------❑-- <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam ay Loam E] Clay E] Adobe J�r Hardpan Ej <br /> iiii, Previous Application Made: Yes E] No � Gravel <br /> Construction: Yes,j��NElay <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Septic Tank-. '%F Distance from nearest well------ ------Distance from foundation_---___--------Material-_----------------------------------------- <br /> T ,e_4 N lx -, o. of compartments------------------ ------Size--------------..-_..------Liquid de fh Capacity...---–---........ <br /> - ---]j '490 .1 $4 <br /> Dis Distance from nearest well Distance from foundation--.37-7 ---t-o---nearest lot line_ ------ <br /> Number of lines _",.JZ Length of each line_,__5-__(1 ------Width of trench-- <br /> Type of filter material''_ 'Depth of filter material---- length_._.._._-_ <br /> ------- -----------Total -------------- <br /> fo eI / <br /> Seepage Pit: Distance to neareMsweII__/_6_Z.I`--------Distance flWini,foihdation-- - ------------Distn�e to nearest lot line--2-0---- <br /> kae Number of pits-- ---- --------Lining materral.,A�_- _rze: iameter------3------------Depth-------;F1 1� <br /> Cesspool: Distance from nearest well__._._____Distance from foundation.-.................Lining material-..___...._.------------____. <br /> ❑ <br /> aterial------------ ------------------ <br /> El Size: Diameter-------------------------------------Depth--------- ---------__----------- -------Liquid Capacity----------------------- <br /> apacity---------------------------- ais. <br /> Privy: Distance from nearest well.__ _--- ---------------------------------------Distance from nearest building----------------------------- -----14 <br /> El Distance to nearest lot line.------------ ------------- ----------------- —--------------- <br /> kee <br /> ------------- ----- <br /> ii,er Remodeling and/or repairing (clescrilz <br /> • <br /> - --- ------ - ------- <br /> ------------------- ------------ - <br /> ------------------------ -------i- ----- ----- - <br /> ------ - -- --------------------N6 <br /> I ---------- <br /> ----------- ------- ---------- - ------------ ------ __1------------ <br /> L ------ ----- - ---------- ------------- --------------------------------------------------- --- ---------------------------------------- --- County <br /> --*------- <br /> I hereby certify that I have prepare this application and that the work will be done in accorda e with San Joaquin ounty <br /> ordinances. State laws, an rules and�Ila s oft S n Joa uin al FEalth Districi <br /> - ------ w r and/or 06nfractorl <br /> ------------_--------------------------- <br /> By I 2�� 't� <br /> A11K - ----(Till f lie) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, eta, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...---_ ----------- DATE---------------- <br /> REVIEWED DAT <br /> BY------------------ <br /> BUILDING PERMIT ISSUED--------------U-------------... <br /> --------------- ------------... E------------------------------------------------------- <br /> -- _---------------------------------------------------- _----------- DATE------------------------------ ---------------- --- <br /> Alterationsand/or recornmendafims:---------------------- ---------------------------------------------------------------------------------------------------------------.---------- <br /> --------------------- ------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- - ------'------------------------------ ------------------------------------------------- - -----------------------------------------------------__------------ <br /> - -- ------------------------------ ----------- ----------- ------I----------------1-------------L --------------------------------- -- -- ---- <br /> -- --------- ------ -- ------------- ------ ---- -=- -------- -----... ---- ----------------------------------------------------------- -- ---------- ------------------------------- - - - <br /> * * ---------- ----- <br /> ITFINAL INSPECTION BY:-- Date-----------1----� ------- - - --------- <br /> L SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wed Oak Street 132 Sycamore Street 814 North "C" Sfre.f <br /> LStockf.., California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />