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d " ' o. <br /> ppLICATION"FOR SANITATION PERMIT Permit N <br /> A <br /> / <br /> ,., (Complete m Duplicate) <br /> Date issued ---- 9!-a-------- <br /> •� +• b made +o the San Joaquin Local Health Dis+rict for a permit to construct and install the work herein described. <br /> Applica ion,is hereby <br /> This application is made in compliancewith- unty Ordinance-No <br /> +� Or No.--544.�J <br /> ----- -Sf- - � ----------- ---------- <br /> OCATkON__."- = f-_" ----------- - -- <br /> JOB ADDRESS AND . - ----.- Phone-_ - W -- <br /> -------------- <br /> Owner's Name------ o y - -----------•--=-----------------•----- <br /> 6 <br /> /G <br /> I e <br /> •----- Phone ` <br /> ------------------- <br /> ;n.;------- Other <br /> � <br /> tor's Name--_-"Contrac <br /> Installation will serve: Residence,[Apaiment House E3 Commercial Trailer Court Motel ❑ <br /> --- <br /> Number of bedrooms _ " Number of baths <br /> ------------------------------ --- <br /> Number of living units: J--- I ' <br /> CommuI. s stem ❑ Private ❑ Depth to Wafer Table <br /> Water Supply: Public system [L� , # y Y Clay Loam ❑ Clay ❑ Adobe p- Hardpan ❑ <br /> Character of sail fio a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Y <br /> Application Made: Yes F1, No j j �New.Construction,:_Yes• Na <br /> Previous App' _❑. r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or.cesspool permitted if-public sewer is available within 200,feet.) Material" --`--- ---"--- <br /> ----- Capacity--gS-d , <br /> ZL <br /> I <br /> Septic Tank: ' ' Distance from nearest well�� Dis+ante from foundation"" _D- ---{- � <br /> No. of compartments a _ .."... Size`S6 xy�-------------Liquid depth ." <br /> Distance <br /> Disposal -ield: Distance from nearest weli'�?o± �enath ofreach line at;��---D�-F W+dth ofttrenche5 �}t lot ;ne---------------• <br /> Number of lines g <br /> j Type of filter mater Tal""S._�_9"Ck-----•[3epth of filter material----��-----------Total length--------�-'-�-----•-----------r�----- <br /> pit; Distance to nearest ell -Dista from foundation_.__-;�A----_-_-.Distance to nearest lot line-""S""_"------ <br /> -------- <br /> Seepage W� $'� RC 3_�- Depths ' = <br /> pa Number of pits----_..I:"-.-.-------L•ining material""--_j$)7!""k_-.Size: Diameter_." - <br /> s <br /> Cesspool: from neargst�we_ll---------- ---= Distance from foundation- `"Liquid Capacitying t erial------------------------------------- <br /> Distance gals. <br /> - q - <br /> -----.Depth-------------------------------------------- <br /> --------------------- - - ------ ------- <br /> ❑ Size: Diameter"----------------------- - Distance from nearest building <br /> ' Privy: Distance from �Barest well_.--__""_."_".- - - " <br /> -------------------- --------- ------ ----- <br /> ------------------------------------ <br /> ❑ ti Distance to neaarest lot• ine__."-"--------- ----- - . <br /> ' ------------------•---- <br /> Remodeiing and/or repairing (describe):------------------------------------------------------ _----_______"_"_"" <br /> ---------------------- <br /> •------- <br /> -----•-------------------------- ---•--------- - ----------- <br /> i ----------- <br /> that <br /> ---------- ------------ <br /> - I hereby-certify.that I have ,prepared this s-application <br /> the San .laaqui hLocalkHealtheDi District. <br /> ordinances. <br /> accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations % Contractor <br /> —� -- <br /> 1 --------------- """_".. -"___. """-"_ <br /> -"-""___ , <br /> (Signed) (Title _-• <br /> .. c-- <br /> By:-----------------". . - ----- ---•------- --------- etc., can be placed on reverse <br /> (Plot plan, showing size of lot, location of systemin relation to wells, buildings, side). <br /> FOR DEPARTMENT USE ONLY <br /> ---------- ----------------- <br /> --. DATE----- - -------------------------------------------------- <br /> APPLICATION ACCEPTED BY- : DATE `j - -- - -----------•------- <br /> . ." - ------------------------------- -----•------------------------------ -------• DATE ` � ----------------------- <br /> REVIEWED <br /> BY----------------------------------- ---------- <br /> ` BUILDING PERMIT ISSUED".-------------•------------���------=-----------•-------------•--------------•----------------------••----------------------.----------------------- <br /> A <br /> -----••----- ------------------- <br /> BUILDING PERMIT <br /> and/or recommendations:.""""" ---- -----------------------•--------------- <br /> ------------ <br /> --------------- <br /> ------I-- -- ----------- -------- <br /> 1- Date °_ = ------ <br /> ------------------- <br /> FINAL INSPECTION`NBY.-_" <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street <br /> 300 West Oak Street Tracy, California <br /> 130 South American Street Lodi, California Manteca, California <br /> Stockton, California <br /> eu R...«ad W2100 <br />