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rUK UrP%_r Uat: <br /> ..................W--------------- ....... <br /> ...................I......W.......................... APPLICATION FOR SANITATION PERMIT Permit No. .-PfZ <br /> ........... ........................­........ .......... (Complete in Duplicate) <br /> ............................... ...................... ... This Permit Ex biros I Year From Date <br /> - IDate Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit <br /> This application is made in compliance with County Ordinance No. 549. to conA endinstallinstall the work herein described. -,j <br /> JOB ADDRESS AND LO ATION_A­,_ <br /> . <br /> Owner's Name....... -- ----- ...... <br /> ------------------_--- <br /> .................... <br /> ................. .. <br /> Address.............. �. <br /> 9 . .............-------------------------•-------•-- ------ ................V..........­ X <br /> -------------------....... <br /> t.......... <br /> Contractor's Ama.........................�ez-4/4/ <br /> A 2 lull-,�7 , BEfl <br /> Installation will serve. RqEOdertce-EI%Apartmenf 46"Z`se 0-Commercial 00 Trailer ourt Motel other <br /> Number of living units: -------- Number of bedrooms -------- Number of W t sl_)��Lot size ..j9/1A4/ <br /> W _4�....................................... <br /> ater Supply: Public system [] Community system E:] Private Ll Depth to Water Table ft. <br /> Character of sail to a depth of 3 feet: Sand E) Gravel Ej Sandy Loam [] Clay Loam❑ Clay 0 Adobe 0 <br /> Previous Application Made: jIf yes,date....................I No Now Construction: Yes No 0 FHA/VA.. Yes 0 No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS, <br /> (No septic tank Of Cesspool Permitted if p#it sewer hill200 feet.( <br /> is available <br /> -STc-Ta-rk:''-=isli6c-e;-fi.'o-r,-I-ne—arrsf-,.,iI <br /> Di <br /> is a Mate <br /> . ..........1­ <br /> No. of compartments......2�-__ 0 ........ <br /> rQ1 n..... <br /> size A <br /> IVY - ---------- <br /> qyid.dipth...._1Y............._...Ca . ....... <br /> Disposal Field: Distance from nearest Distance fro <br /> i't ­ A 4 <br /> Mn�7�_/ Dis7drice to nearest lot ........ <br /> Number of lines.....1....____._,_ ........ 0 <br /> Type of filter tn� .......width of trench-'-­"-V_(?..!------.......... <br /> �Wl)epth of filter material.....)AP.;' <br /> '.....___Total length__/&T:�......................... <br /> Seepage Pit: Distance to neat Ve ............... Distance from anceto nearest lot line__._.........____ <br /> ❑ Number of pits......................Lining material.............__..- <br /> ....Size: Diameter..................__Depth"................................ <br /> Cesspool: Dista from nearest well.................Distance from foundation--------------------Lining material........._„-..-_----. <br /> El Size; M-ImsfOr--------------------------------------Depth_---------------------------_------------_-----Liquid Capacity.._............. <br /> Privy: Distance from nearest well----------------- _.gals. <br /> --------------------------------Distance from nearest building......................................... <br /> 0 Distan6 to nearest lot line <br /> --------------------------------------- ............................ <br /> Remodeling and/or repairing (describe)______________ <br /> -------- <br /> .............................................I--------.................-------------------------------------------- <br /> ....................................I.............­..­--------­-----------r­1...... <br /> ............ .. - <br /> ....................I.................... <br /> .................................................................­1............I..........................................................I.........I......I.................. <br /> ­....................................................................................................................................----•-•--•----••-•------......_..._........--:.......... ....... <br /> I hereby certify that I have proper this application and that the work will be done in accordance with San Joaquin.County <br /> .- <br /> ........ <br /> is <br /> 0"s C <br /> or ...............•-.........-•----------.......---•----•-.............. <br /> State laws, and rules and 9 la ons of the San Joaquin Local Health District. <br /> (Signed)..............................:1_.....__........ -- ------ ----- ------ .....................................................................................(Owner and/or Contractorl <br /> **---------- ” ­---- ----- <br /> By:...................................... .... <br /> (F!!jfplan.,showing size of let. location �y#!,, in r................................I...........................(Title),............................................................. <br /> system lotion to wells, buildings,Id _gs etc,can be placed an reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - -------­................................................ DATE----- <br /> REVIEWEDBy---------------------------------------------------------------------------------------------------------.................... DATE........................ ............................ <br /> BUILDING PERMIT ISSUED...-................... _-----------------------------_-------------- .... DATE......................... <br /> Aheraflons and/or recommendations;------------ <br /> --­----------­I......I.........................I...................................................................................................................................... <br /> . <br /> .............. ..........I.......... ...........I............... <br /> ...................................... ..........................................................................................I....................................... <br /> ..............I................I................. ............................................................................................................................................................................ <br /> ----------------..........................1.............. -------------------------------------------- ...........I.............................I....................................................... <br /> FINAL INSPECTION <br /> ............. <br /> BY:.... Date__...fl.._. .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 south American Street 300 West Oak Stmi 124 Sycamore sjr99# <br /> Sfa4;k1*r1,catifornia203 West 9th Street <br /> ED 9 REVISED 9-99 EM a-fit ATLAD Lodi,Callfornin MOMNCOr C01119MICI Tracy,California <br />