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..3.K-, <br /> SANITATION PERMIT Permit <br /> APPLICATION FOP, SA <br /> (Complete in Duplicate) Date issued <br /> licafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> App . made in compliance with County Ord" ce No. 549. <br /> r-lis application is ro"I <br /> % ---- ----------------------------------------------- <br /> OC�9ON-----A-- .......0,00__.41 iZ <br /> JOB ADDRESS AN I — Phone__ <br /> ------------- <br /> Owner's Name---- --- ----- -- ---------------- -------- <br /> 1� P�----------------------------------------------------------------------------------------------------- <br /> Address-­Oz, 4T 7 <br /> ----- ------------ -------------- <br /> ame----- <br /> Contractor's Name______.__ --- - Motel <br /> 1P 11 Commercial [] Trailer Court El Other 0 <br /> Installation will serve: Residence Apartment House 0 -------------------------- <br /> Number of living units: -- ---- Number of bedrooms ,�;!Z Number of baths __/--- Lot size <br /> Water Supply: Public system Community system [I Private [] Depth to Water TaUe J�ft. Adobe Hardpan E] <br /> X Sandy Loam [I Clay Loam El Clay E] <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 171 YesNo Fj <br /> s Application Made: Yes C] NO New Construction-. x\ <br /> Previous 09 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: in 200 feet.1 <br /> (No septic tank or cesspool permitted if public sewer is available with -.Material----------------------------------------------- <br /> No. <br /> from nearest well-----------------Distance from foundation------------------ ------------- <br /> eptic T nk: ------------------Liquid depth--------------------------Capacity_-------- <br /> No. of compartments--------------------- ----Size--------•----- <br /> U anon-.-.-_-_- Distance to nearest lot line--_------_------- <br /> 4D'i-sposal F* d: Distance from nearest well---------------.-.Distance from o nd Width of french -- - <br /> N um ' lines------------------------ Length of each line---------------------------- ----------------------- <br /> ber otlength-----.----------------- <br /> "'!V <br /> -- ---------- <br /> T ---------- Depth of filter material-----------------------Total--------------Total length-----I <br /> Type o' filter material ---------------D �nearesf lot line------5'__ <br /> un ation---- ------Distance to <br /> `nearest <br /> to nearest well-,ov------ from- ------ <br /> Seepage it: D' <br /> mate�iai _Size: Diameter---------------Lining <br /> Number of pits_--y <br /> Distance from nearest well-----------------Di�ta�n,, _ror� f_o__u`ndaf ion------------- ------Lining mafe6al------------------------------------ <br /> sspool❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liqu�d Capacity- --------------------------gals. <br /> --Distance from nearest builcling------------- ---------------------------- <br /> -Dis <br /> Privy: Distance from nearest well_______________________- ---- ------ ----------------------------I- --------------------------- -----­­---- ---- <br /> to nearest lot �ine-------------------------------------------------_ . �Z , <br /> ❑ <br /> - ---------- - --------------- <br /> ------------ <br /> Remodel- g and/or repairing (describe): ------------------------------------------------------------------- <br /> ------------ <br /> --- ----------------I------------------Z ---------- --- <br /> - --- -------------- -------- ------------------------------------------------------------------------------- <br /> -------------------------­--- -------------------- <br /> - ----------------- -------------------------- ------ <br /> ------------------------ ------------------------- <br /> ---------------- -------- -------------------------------------------------------------------------------------_ with San Joaquin County <br /> - ---- ---- ----- <br /> - -------- - <br /> --------------- <br /> /---------- <br /> I hereby ce .'y that I have prepared this application and that the work will be done in accordance w <br /> ordinances, tat la s, and rules and regulations of the San Joaquin Local Health District. {Owner d/or Contractor) <br /> or <br /> r <br /> --------------------- -- -- --------(Owne <br /> - <br /> BY: -------------------------------- rs <br /> -(Signed). ----------- ------ - ---- ------------------------- ---------------- <br /> • _---------------- <br /> By:---------------- <br /> % ed on rev rse e-). <br /> (Plat plan, showing six of lot, location of system in relation to wells, buildings, etc., can be(Titlep <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------- DATEI�t------------------ --------------------------------- <br /> APPLICATION ACCEPTED BY ------ DATE----' -- ----------------------------------------------- <br /> --------------------------- --- --- ---------------------------:------------------------------------ <br /> REVIEWED BY, ____V_ DATE---------:.�---------------------------------------------- <br /> ---------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------- -------- - --- ------- ---------------I------------- <br /> Alterations and/or ommendations'. j--.---- <br /> ----------- ----------- ------ <br /> - ------------- <br /> -------------------V- ------!=,---- --- -----------------------j-----------------------_#----------------------------------------------------- <br /> Q----------------------- -- ----------------------------------- -------------------------- ­--------- --------------------------- <br /> - ---------------- -------------------- <br /> - -----------I------------ ---------------------I-------- ------------------------------------ --------------------------------------------------- --------------- -------------------------------------------- <br /> ------------------------I ---- ---------------------- ----------- -------------------------------------------:------------------------------------------------------------------ <br /> Date.. -------------------------------- <br /> ­(�FINAL INSPECTION BY:-----1� --- -------- ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 3oo West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street Manteca, California Tracy, California <br /> Stockton, California Lodi, California <br /> r5-9-2M 10-52 Revised W-2100 <br />