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FOR USE: <br /> .E <br /> ` Permit No. _"._ !__ l.. <br /> r APPLICATION FOR SANITATION PERMIT <br />-------- ------- ------------------------ <br /> (Complete in Duplicate) Date Issued .-3 -- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to struct and in II t ork herein de c d. <br /> This application is made in compliance with County Ordinance No. 44. ca C i <br /> AT— <br /> This <br /> ADDRESS A OCAT N__ - "" --- a y <br /> �'� Phone. .: -J... <br /> Owner's Na - ------------ ` <br /> ---------•---�-�--� <br /> A ---------- <br /> ------­--------------------- <br /> Na <br /> Address-----------��'"c.�.t._!.c---��?`-=--�---'-'--•f-�-c�---- ---r--- -- - -- - <br /> Y <br /> -�-- <br /> Contractor's Na�s-----� � ...._ �-�r. � f '�-i - - l o[3 Other Ph �- - <br /> Installation will serve: Residence ❑ #Apartmen House ❑ Commercial a Trilgr Court ❑ Mote her ❑ <br /> Number of living units: ___--_- Number of bedrooms _-__--- Num er of baths -,_- """" Lot size --1----------- - <br /> 9 <br /> Water Supply: Public system ElCommunity system [IPrivate ❑ Depth to Water Table " ft. <br /> f soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay ❑ Adobe Hardpan I❑ <br /> Character o p No..E] <br /> Previous Application Made: (if yes,dcite_ ------ ---- ----) No ❑ New Construction: Yes No FHA VA: Yes ❑ it <br /> ftp <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if'public Se er 1s available within 200 feet.} ' ,r9 `� p Q <br /> I / __ �it <br /> Se5;� <br /> iTank: Distance from nearest well_ " _ frl <br /> Dis#ante fro foundatin"Liquid #�- �er�ai_" : Capacity..""_".!- -4�? d <br /> --- --.-Sizer-,�'� P. °� <br /> No, of compar#merits-�.._-"."---- <br /> IF I <br /> Disposal Field: Distance from nearest well-TJ Distance from foundation"" __" """"_" <br /> .--Distance to nearest lot line__- <br /> Number of lines-"" _-__" Length of each line--_.-' -- �.o"�� ----Width o gtren J------r, —It <br /> C� .Total' len length---- -------------- [� <br /> Type of filter material `'5-Depth of filter material_""� -."Seepa a Pit: Distance to nearest well-fl` --� -Distance rom f undation""- ? -- <br /> ---Distance to nearest lo�; <br /> ii ----Size: Diameter--- g Depth_ <br /> Number of pits.---1-"""------------ Lining material___--- <br /> Cess ool: Distance from nearest well------- <br /> gals <br /> from f ndation Lining <br /> Capacity I <br /> pgals. <br /> ❑ Size: Diameter-------------------------- ---- -- -De th-------------------------------------------------- q pac-Y---- - I <br /> Distance from nearest buiidin <br /> Privy: Distance from nearest well---------------------------------------- ----- <br /> r d <br /> -- <br /> ❑ Distance to nearest lot line---------------------- <br /> Remodeling and/or repairing (descri ey:_- O <br /> 3.� ----- <br /> -- --------- <br /> ------------------------------------rl----------------------------------------------------------------------- ------------------------------------------------------------------------------- --------------- <br /> I hereby cer ify that I have prepared this application and that t e work will be done in accordance with San Joaquin County <br /> ordinances, St ws, d rules a regulations of a San Joa Local Health District. t i� <br /> ------------------- ---------- or-Contractor) <br /> (Signed_ .. tl k"... n <br /> E - --(Ti -------- <br /> e} <br /> r <br /> By:. <br /> (Plot plan, showing size of lot, location of system in relation to !is, buildings, et :, can be placed on reverse side}. r <br /> }. FOR DEPA MENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------- <br /> ------------------------- DATE T `= <br /> r DATE-------------------------------- ------------- -------- <br /> REVIEWEDBY--------------- -------------------------- ----------------- --------------------------I <br /> PERMIT ISSUED------------- --------- ------ <br /> DATE__:--------------------- -------- <br /> --------------------------- <br /> i Alterafi.ons,aare 0 me a ----- <br /> •-------------•-----•--------------------- y <br /> -- <br /> os ------------------------ -- --------- ----- ------------------ <br /> ~-- --------------- --------- <br /> " " Da� <br /> � <br /> a. <br /> I �R_ ----------------------------- <br /> FINAL INSPECTIO BY:- --- ---------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT I <br /> r 1841 E.Haiellon Ave. 3oo West Oak Street— b 124 Sycamore Street 205 Wtst 4t�Srnjai,/ � c <br /> Lodi,California a C f rj'ie T+ <br /> •,'(�� Sl7 <br /> ock5t/amort,C ii}arni �/ / �,,,�� � ,• e, p <br /> QS 9 R�5EG 9- M 3-' F.P.0 O. <br /> 1 � <br />