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Permit No. __ _ 7..�`.- <br /> APPLICATION i ,t SANITATION PERMIT C <br /> (Complete in Duplicate) Date Issued <br />��. <br /> • r Applica+ion is hereby made to4,& San Joaquin Local Health District for a permit to construct and install the work herein described, <br /> 't7his application is made in corn lien a with County Ordinance No. 549. (l-$,3— 030--.SE, <br /> fit-- ; I <br /> JOB ADDRESS AND LOCATION_..`First--new houe.e--_gn--Ns3rth_-side of ser ant Rd. EaBt Of <br /> En -2 44 <br /> .� #tone Road# Lodi ---------- Phone._ ---------' ----------- <br /> --------------- <br /> Owner's Name---.(�.�Y�ext .1f�c^?^TC1k' .� ; ', -------------------------- <br /> ------------------- <br /> Address--------------A 1�.TB Q __2$_7�R-, <br /> . ... o 1.:.•:C a13 HO 3­7727 7 7- <br /> De`�: a Se tic Tank Service*---Inc.-------------- ------ Phone -------- •----------- <br /> Contractor's Name------.... - P <br /> Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Installation will serve: Residence ® Apartment House ❑ ❑ acre <br /> ---------------------•- <br /> Number of living units 1.-___ Number of bedrooms 2_-__ Number of baths�r ---- Lot size _____ _______________ - <br /> Water Supply: Public system ❑ 'Comm uniiyy,;system ❑ Private ® Depth to Water Table Q-_ ft. Adobe Hardpan <br /> Character of soil to a depth of 3 fee 5and�❑ Gravel ❑ Sandy Loam d Clay Loam [ Clay ❑ ❑ P ❑ Y <br /> 41 <br /> Previous Application Made: Yes ❑ No [X New Construction-. Yes ® No ❑ ��+ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> well__ .____f--Distance from foundation___ -Q_;______-.M�teriaLC*- C <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet.)- <br /> P effieIl brick. <br /> t --------- <br /> ----------------- <br /> i Septic Tank: Distance from nearest t Capacity X00 <br /> --- ---2.. .. _1 Size-At-X51__ ---- ----- - --Li uid de th- ' p Y <br /> t No. of compartments_ - G + <br /> Disposal Field: Distance from nearest well..����--Distance from foundation .__.Distance to nearest kotiGne_ ._.___. <br /> '- �. <br /> ' l Width of trench-----o2--------------- <br /> Number <br /> =-------- <br /> ® Number of lines---------� - ---Length f each line__--_� .. ............ <br /> Type of filter material _.__ ... <br /> ____-_Distance from foundation_-.____. _ ���c��ce.,to�r�earest lot line_____._..-j-�,- <br /> y rock <br /> Number of pits.------1------------Lining material -----�------ Si�e: Diameter__... De <br /> pt----•------ <br /> -- -- --- <br /> Cesspool: Distance from n�ea'rest weVl------------___Distance from foundation__.._-__. __._____.Lining mater�al___.__________-__._ <br /> Size: Diameter Y ...__ De�' - - Distance from' nearer{kbu apautY 9a <br /> ❑ r. I <br /> ilding--------- ------ <br /> i ` Privy: Distance from nearestt�+ell-.- y, t <br /> - -- •---- <br /> Distance to nearest lot line----- --- <br /> N"A_ -- _-•----------- --------------------- <br /> l ❑ - <br /> r <br /> eW ----------- <br /> Remodeling and/or repaEring (describe -------A ----------------------- <br /> Is <br /> ---- •------------- 1 . a---------------- <br /> -----•------- ._.... <br /> + <br /> ------------------------------------------------------------------ <br /> __________________________________________________________________, <br /> ----__________ <br /> I _____-_--_________-._______________ <br /> __________ ________ _ _ -.-_____.-__-.___._____________--________-___ <br /> - <br /> 4 I hereby certify that I havere ared this application and tha+ the work will be done iit accordance with San Joaquim County <br /> ' ordinances, State laws, and rules and regulations of i s n,Joaquin Local Health District:y., r <br /> Si ned Delta. 5eRtAc-_Tank__aervice,_.Ine *---.- <br /> --- -------------------I--------. ---_-.--(Owner and/or Contractor), d <br /> (;9 ) -ITit1e) Gen. -Mrs - - `- --� -------------- <br /> ------- . <br /> ferry.Warthan ._ <br /> (Plot plan, showing size of lot, locationof system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__ --- - <br /> ::: DATE- GP _. <br /> ~DATE - • ---=---REVIEWBY---- ------------------------------ -------- --------------------------- ----------------------------------------------- <br /> BUILDING <br /> ----- ----- DATE__.. <br /> BUILDING PERMIT`ISSUED-------•--------- -- ------------------------------------------------- <br /> Alterations and/or recommendations:------- -- ----------- ------ ----------------------- --------------------•--_� _ --- ••------------- 0 <br /> ------ ------- <br /> ---------------------- ------ ----------------------------------- <br /> ---------- <br /> ----------- _----•------ <br /> ----- ---- ------- ------------------ .. <br /> ,� .,,, <br /> ' e <br /> Date..'�f <br /> . l d' <br /> FINALINSPECTION BY: --------_---------------- <br /> SAN <br /> ------ --� �-�- <br /> SAN <br /> ;J <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street y <br /> Manteea, California Tracy, California <br /> Stockton, California Lodi, California <br /> E5-9 145446 A7W00❑ <br />