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APPLICATION FOR SANITATION PERMIT Permit No. I!A---q.:V* <br /> M�o�o�o � a <br /> This Permit Expires I Year From Date Issued(Complete --''---' Du�/ /�uod �!�i' � <br /> Application is hereby made to the San Joaquin Local Health Dist ricf for a permit to constru f and inLsfall Ztherj keoin descriUd. <br /> This application is.m.acle.in compliance with County Ordinance No. 549. 14 4 <br /> tzi�4.--'If 19 A <br /> - j­______� ---------- --k-----V-4--�-------aw--------------------------- <br /> ----------------------------------- <br /> Installation will serve: Residence rtmentHvuse Commercial Trailer Court Other [:] <br /> Number of living units: Number ofbedrooms ..l�-Num6er of 6oHm I- Lot size IK-11-1� -__---_-- <br /> _�� ) <br /> W� Supply: Public system E] Community ssystemE] PPrivate � �� � Water Table ��.. ft. <br /> � <br /> ��hara�erofsoU to a depth wf3 foot: Sand E] Gravel [] Sandy Loam &��- C"/uy Loom [] Clay Adobe Hardpan [] <br /> Previous Application Made: Yes E] No E] Now Construction- Yes [] No [] pHA/VA. Ye, [] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' ---� <br /> (N* septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> , <br /> Distance from ~ 5 �� f ---- <br /> Septic Tank: � ' <br /> ~ <br /> No. ofcompu ~-- S -7.� _13 ,'�d dh j.1 <br /> Disposal Field: D�ntonco from nearest well unce from founclotion.10' xmA4'.Iristunce to nearest lot <br /> Number of lines '~ /,,Length of line ..�^�� ��� <br /> _ / . Vi6f� of +ropc� �� <br /> ^�*�--~~-� <br /> -.-. <br /> Depth of �|+mr mv+�rio------ � ��� ofo| length of filter ma+o ---------------------- <br /> Seepage <br /> ------ <br /> Seupmgu Pit/ Distance to nearest well----------------------Distance from founclmtion--------------------Distance to nearest lot line--. <br /> [] Number cfpits----------------------Lining material -.-----Size: Diameter_-------------------- <br /> : Distance from neu,n, well -'''--Distance from fowndot;on--------------------Lining motmhoL''_-_-''' <br /> E] Size: Diameter------------- ---------------Depth--------------------------------- ,------------------Liquid Capacity,--------------------------gals. _ <br /> Privy: Distance from nearest well-..�--------.-��_----.Did*noy from nearest-building--'—_--_-----^~°" <br /> [] Distance to nearest lot line�'�����-���''--�'---'----------------------- - ~ ''-'-'''-_'-''-'-'_— <br /> � <br /> Rvmo6�ing on6/", repairing /�e`crib��._----_-_----'-_-_-.__-'--___---�.�_-_--�..--_____ <br /> ._._-_..__-_—.___-__-_-_-__-_--_-___.-----_--.__-_--_--..-----''--'__-._—________. -n= <br /> '--------'-----------'---------'--------------------------'---------'------�-- <br /> < ' <br /> '-''-'--_-'--��-'-'''--'----_-''___--_---_----_'''-----_.'-'''--_-__-_-.-_''__.--''--'----''— <br /> hereby that ' <br /> ordinances, Sf f laws. and rules and regulations of the San Joaquin Local Health District. <br /> - - oy:-----�������coo�r;, <br /> _---�.'�.-./�.7`�/'�.��---2-.=_---.�--,-.``-..��.- .`���-. -�..`.. �--_-�-rr-,-"-r~- ~ <br /> ------- <br /> (Plot �mn, showing size uf �m�*n ofyys+em in ,elation to weUs, buildings, etc., �on be placed on reverse side). - <br /> �'USE ONLY <br /> APPLICATION ACCEPTED 8Y-- .»���+./'~�� ������.��'���-. D�TE..r.e �.��.��_-_____ <br /> ~ - <br /> REVIEWED UY------------------ -------------------------------- -------------------------------------------------- <br /> ----------------------- DATE--------------------- <br /> 8U|LD|NG PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------------__- <br /> Al+e,u+iono un6/n, rocnmmnn6af ions:-------------.----_-----_-.---__--___-__._---._.__--- <br /> ----`--`````--'-`--`-----``-```--`--``-``````--------``--- `---`--`--``--````````--`------- <br /> ----'-''--''''--''_-'-'''-_''.-'�-_�'—''''---''''----_-''''--''''--'-'''-_'_--_---'_-'_-.---- <br /> --'-'-'--'---''--''---'''—'---'--''''---''''''--''''---'''-''-'-''''--'—'''-''----'-''-' <br /> --''-'--''-'----'''— '--'''--''''''-'''--''--''—'—'' -'—''-''--' <br /> . <br /> � � � � ^� <br /> ------- <br /> FINAL INSPECTION BY��---/���,��'''��.'�.c�-'--' Du��—''�'��--'������?��-'''-''�_'�-' <br /> SAN JDAQU|NLOCAL HEALTH DISTRICT <br /> /s s"um A=o,ic°" str°o+ 300 West Oak utr°"+ /32 Sycamore Street w* North "C" Street <br /> S+o"kfo". California Lodi,.California ^4^nm*^. California Tracy, California <br />