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OR OFFICE USE: ., J <br /> .: Permit No. ..!-•- • <br /> ---------- APPLICATION FC1R SANITATION PERMIT <br />- / 1-_ �r <br /> X-?�� (Complete to Duplicate) Date Issue f <br /> jThis Permit Expires 1 Year From Date Issued? <br /> lication is hereby made to the SarilJoaquin-Local-Healt coDistrict o a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordina <br /> �JOB ADDRESS AND LOCATION.......... ------ Phone----------_--------------- <br /> Owner's <br /> ��-_'- ------ <br /> Owner s Name------------ ............ ----------------- <br /> s ' ' ........ S � C• d .--s -----"-----"--- <br /> Address <br /> -------------------............... Phone---.......... ---•------•----•---•- <br /> Contractor's Name-.--.-... . <br /> '! = Motel ❑ Other ❑ <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Installation will serve: Residence ® P 3-•-_ ._-.7-_:3._ ..--•••--••-..---••- <br /> x. <br /> room _. Number of baths _.--.--. Lot size <br /> Number of living units: ---- Number of be. Depth to Water Table .--.-_.. ft. <br /> Water Supply: Public system � Community system C] Private C] P Hardpan ❑ <br /> Clay Loam ❑ Clay ❑ Adobe <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Y FHA/u No ❑ <br /> Previous Application Made: (If yes,date--------------t----) No ❑ New Construction: Yes .No ❑ <br /> A. Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 4. <br /> I <br /> (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) <br /> ,�/ P ity_Ick v--(�.... ' <br /> P - Ca aci <br /> G Se ti Tank: Distance from nearest well----- fromfoundation-u�d depth--•, ateria- :_-----_ � ---- •----••-- y,' <br /> No. of compartments-_ Size. -T _ 1 q W <br /> ----�_-' •-- <br /> 1 <br /> Dis Sal f=ield: Distance from nearest well__.----�- Denath of reach line ation._C.0 __ Width ofnce tfrenche st'o e O <br /> �, i 6 .. <br /> Number of lines,_.._--.__.3� ------- g _ <br /> Type of filter material.-. 'f-/'--Depth of filter material--------- lengt _.---••-• -• -• j <br /> 1 <br /> Sge ge Pit: Distance to nearest wekL__----_- Distance <br /> e_{ren�'f?v 5ixe:nDia titer---_�t3 Z-0—.-Distance t--Depthst -- ------------------ <br /> Number <br /> ----- - -•- <br /> p. materials <br /> 1 - Number of pits'.___--�-==-------Lining <br /> { Distance from nearest well_________________Distance from foundation----------•---------Lining material___---__--•--•--- als. <br /> 1 Cess ool: '' ------- 'De th_------------ -----•----------------------------- liquid Capacity. ° 9 �. <br /> ❑ Size: Diameter- ------------------- P j pis#ance._from�aearest buildiri.---- <br /> I 9 ---- ------------------•--•--•.-. <br /> Distance from nearest well --------------------- -------•-------- <br /> Privy: -•--•-- --•---- <br /> ❑ Distance to nearest lot line----------=--•--------------------------------- <br /> --•---- <br /> -: . <br /> Remodeling and/or repairing (describe): -- - -- - - -•--•----••-•---------- -----------•------- ------­-----------------. . <br /> .- <br /> l <br /> ------ •----=•- i <br /> ----------•--------------"•-"------------------------; _----------in• --------- e • ----a ------qui <br /> - 1 hereby certify that I have prepa'edulati ns of-the-San-JoaquinlhLocal kHealth eDistr ctn accordance with San Joaquin County <br /> ordinances, State laws, and rules and g. _ (Owner and/or Contractor] <br /> (Signed)-_---•------------- --------- ----------°----..------•----- = = n be l <br /> Title <br /> ----------------------------- ----{ <br /> BY:........................................±----------------------------- aced on reverse side]. <br /> {Plot plan, showing size of lot, location of system in'relation to:wells, buildings, etc., ca _p <br /> k t FOR DEPARTMENT•USE ONLY <br /> iU -------------•-------•------•------- -----" DATE -� l-1 -•--------------. <br /> APPLICATION ACCEPTED BY--- ---•------ ---•- DATE------------------••---•-------- ------- f <br /> ------------------------ DATE - <br /> OYIEWED BY-------------------­---------- --------:.....--.-.. --Z, ' <br /> --------- ••--••-- ------Js�/ — � r,�.. <br /> 1 BUILDING PERMIT ISSUED- . . ----------------- - ---- -••-----•• --------------------------- ------•- <br /> ( Alt anon nd/or re men ions: -- -_-. .. --------- <br /> -- <br /> - <br /> -•_ --•-- <br /> --------------- •--- ------ -- <br /> ----- <br /> FfNAL INSPECTION BY-------- ---------- --- ------- <br /> ------- Date.----------•---�---•---•�--•--- -- •-- --- <br /> SAN JOAQU LOCAL HEALTH DISTRICT <br /> West Oak S�riet 00 We <br /> 130 South American Street Manteca,California Tracy,California 124 sycamore Street 205 West 9th Street <br /> 3 <br /> ' Stockton,California <br /> Lodi,California <br /> EB 9 REVISED 6-89 ZM 6-61 Ar LAS <br />