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FGR OFFICE USE. <br /> :� t ry. r APPLICATION FOR -SANITATION PERMI"I Permit No. .:::.� ...�... <br /> ... . . /E" ��.. . (Compleia, in Duplicate} <br /> ;zs . This Permit Expires 1 Year From Date Issuers Date Issued <br /> Application is horeby made to the San Joaquin Local Hee..ith District-;or a permit to construct and install the work herein described. <br /> This application is mode in compliance with County Ordinance No. 549_ 4�! � Q ` ' -•..• "- �G•� r. <br /> e <br /> JOB ADDRESS•AN�CAT_l0f�f._...--�1� .... ...J... ..rl...... C.r-t Ll1 ... ........ .-.G�.-.I�I..Cl <br /> Owner's Name-...... . ...:G?itJ._ - Phone.................................... <br /> Address....... r <br /> Contractor's Name.._.... � ...... ..,�-......... �d�..-.. Phone...................... � <br /> ............ i S <br /> Ins`allation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote: © Other G x <br /> Number of living units: ..L.. Number of bedrooms 3. . Number of be$sZof... Lot size .......•...••••• � <br /> Water Supply: Public system ❑ Community system ❑ Private []I,4epth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Ii Hardpen❑r+` r <br /> Previous Application Made: lif yes,dLN <br /> ote.,...... - } No Q/New Construction- Yes o ❑ FHA/VA: Yes ❑ <br /> No ,`,- t' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well... C.`.....Distance from founda'ion../!,^-:"-....-..Matt r 1 rne-..-.:: <br /> . .. -.... . . Ca acttY Tts-No. of compartments.... .. Size...... Liquid de --.-.1. •- <br /> rr, <br /> DisposalFieid: Distance from nearesf wee- �F ......,.Distencp from foundation....fe...-...-.Distance fo nearest lot hne, �- <br /> Lr! Number of lines..........'Z-. ..... ........Lengtn of each I:np_ r�.�.�... Width of trench.... <br /> .1 DD rr / <br /> Type or filter material....-1 n...- �t)e th of sifter mater a1.....L9......-.....Tatal length..... _ <br /> 5eeoag P1 1: Distance to nearest ...Distance ffejn f uncation.-1G... <br /> .......Distance to nearest lot lineS ', n <br /> Number or prfis...... . .... .. <br /> Lin; nater ar.... -.- -. ze: Diameter. <br /> �j... -.....-.Deptn-...... a r. <br /> Cesspool: Distance from nearest well .......Distance from foundat;o,R- Lining material........... <br /> ❑ Size: D;d-meter.... .... .. . . .. ....... .. Depth....... ....... .. ...... .....Liquid Capacity......... gels. <br /> Privy:- 0;star4e from nearest wuk..... ............................. .. ... ..D ;lance from neatest building...-......._.... <br /> [ � <br /> LI DiStarlCe to nearest lot line .. . ....... . ...... ...................................._-.........-....---........... tom_` <br /> tQ <br /> _ ` of <br /> Rr_model-rnn ar,d/c,r repair',ra (drs&;be):. ..... .. . . .�.�'.lL•'.. ... .-. C�.�-..� !G...--....../.[)-.S iCc/ ................ <br /> ... . ....... ..................................... ... ........ . ............. • ..................--..............------.....................................I....... <br /> ........,.. <br /> hereb•J certify 4hat I have prepared this application and that the work will be done in accordance with San Joaquin County .- <br /> ordinances, Sta ws, end rules and regulations of the San Joaquin Local Health District. Z. <br /> (Signed) G.� c'. .. ��.�C:, . . -.. . .. ...... .. .. ...... . ... ... ...,..... .. .........,.(Owner and/or on ec <br /> By:.......-.--.., .. ...�...:.....L..f�J..,4.� ' .. ........... .. . .............(Title)-...... ..[,�`.!Pla <br /> f (Plot plan, showing size of lot, locaffon of system in relation to wells. buildings, etc., an be placed on reverse side). <br /> W FOP. DEPARTMENT USE ONLY <br /> APPLICAflOf7 ACCEPTED BY ..... ..... DATE.......! �I-.TrY../r��'................. .•--- <br /> REVIEWED BY... _ .... .... ... . ... DATE........................ ...............-:......... <br /> ....... <br /> BUILDING PERMIT 15SUED..... .. . . .. ...... ...... . DATE.. .............. ..... ........, ..... .. <br /> AEte efio s ane/or recommendations:.. . - . ..- .......... -•............................................. <br /> z�a c«• ,.L.�-r���1[ ................ <br /> r r pl o•: �/ .t�l[. - -'/.+�..� :r ►-..-„a��� ..G . -� .✓.:1.sr�.r....G.;T•Y c-.. ....[..c:ut:;, G�n,�f - <br /> i ., p <br /> F:NAL !NSPECTIQ': BY: — Data„ -. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _ 1601 E-WareNen Aw. 100 Ws+Oak St-1 124 Sy;amore Street 70:Woo 9Th Strort - <br /> st—Wen,collrornin Lodi CaGlo,n;a Man,eea,eaiHornia Tracy,Celilornie _ <br />