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FOR OFFICE USE: <br /> ----------------- -------- ---A------------------------- <br /> X APPLICATION FOR SANITATION ..PERMIT Permit No. <br /> -­--------------------------- ---------- ---- -------- (Complefe in Duplicate)' <br /> Date <br /> IS' if Expitbs'll Year Ff-i5m-Date Issued Issued <br /> --------------------------------------------------------- I Tlh� Pi�r <br /> Application <br /> is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her'in described. <br /> is applicafioF is made in compliance with County Ordinance No. S49. <br /> I Lodi <br /> I'mile south of lftwaxx±2 Harne Rd.on Davies Road <br /> JOB ADDRESS AND LOCATIONA;------------- ----------- --------------------- ------—----------------------------y----------------------------------------------------------------------- <br /> Owne'r's Nam' Valenti---Bros---------------------------- ........ _ _4 ­-------- - <br /> Name-------------------------- ------------ ----------------------------­---------------------------------------- PhoneBW___84_-30-.'. <br /> Rt" 3 Box, 93 Lodi. Calif. <br /> Address...--- `----- ------------•---------•-•---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractors I ' Name__. Se tic Tank. <br /> N --------------—.1--------------------- --+ grVj_Q_e... -------------• ----------------------- --------------------- Phone-------------------------------- <br /> Installation will serve: -Residence [] Apartment House E] Commercial 0 Trailer Court -E1 Motel El Other f] <br /> I <br /> Number of living units: -------- Number of bedrooms -------- N'I umber of baths Lot size .____acxaage---------------------------------- <br /> Water Supply: Public system E] Community system El Private KI Depth to Water Table201- ft. <br /> Character of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loam El Clay Loam 5 Clay [] Adobe E] Hardpan <br /> Previous Application Made: (If yes,date_...__..;--,.__..__-) No 0 New Construction: Yes E] NcME FHA/VA: Yes E] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> -------- <br /> Sep6t-'Tank: Distance from nearest well---501.---Di.5tance--from foundation_-__aW --------- <br /> No, of compartments-------2-------- Liquid depth------4-1------------------Capacity.100gale- <br /> Disposal Field Distance <br /> from nearest well---50--------Distance from foU-ndafion----1.0-4-'----.Distance to nearest lot line.5-1---------- <br /> Number of iines---------- ---------- -----Length of each line-501V---9-0.t.....Width of french--------24fl------------------ <br /> Type of filter material-----roCk--------Depth of filter material—....181 f-------Total length____-_ <br /> --------------- <br /> �Seepade'Pit:l Distance to nearest well-------------- -------Distance from foundation------------ Distance to nearest lot line__.______________ <br /> ❑ Number <br /> ine----------------- <br /> ElNumber of pits----------------------Lining material-----------------------Size: Diameter_------._____--------Depth----------------.--_--;------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> El- Size: Diameter--------------------------------------Depth-------------------------------- ------------------Liquid Capacity----------------------------gas. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_____._______________--______.__ --- <br /> Distanceto nearest lot line..----------------------------------------------------------------------------------- ------------------------------------------------------- <br /> RemodelingaM (describe):------------------------------------------------------------------------------------------------------- ----------------------------------------------- <br /> ---------------­------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- <br /> - -------------- ------ ------------- ----------------------------------------------------------------------------------------------------I----------------- ----------------------------------------------------------------- <br /> -------------- ---------- -------------- -------------------------------------------------------------------- -------------------Z----------------------------------------- ---------------------------------- <br /> I'hereby certify that I have prepared this application and that the work will be'done in accordance with San Joaquin County <br /> I ordina'n'c"es, State laws, and rules and regulations of the San Joaquin Local Health District.' <br /> j <br /> Er l Service <br /> ------------ <br /> (Signed',------------- --- ---- ------ -- ------- --- -------------------- --- ------ ------------ _-rq .'_rfGWRuFvrv&/or Contractor) <br /> rn <br /> - ----- ---------------------------(Title)--------------------- ------------- ---- - - - ------ <br /> (Plot u,dings. etc., can be placed on reverse side). <br /> in <br /> (Plot plan, showing size of lot, location of syvVsfem,i relation <br /> 4 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- <br /> -------------------------------------- ----------- DATE----e-7-JI&----------------------------------- <br /> F I <br /> t REVIEWED BY-------------------------------- -- ------- --------------------- ----------- DATE----------------------------------------------------------- <br /> ,BUILDING PERMIT ISSUED-------------------------------1- DATE------------------------------ - <br /> Alterations <br /> ATE---------------------------------Alterations and/or recommendations:______________ -------- - ---------------------------------------------------­---------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------- <br /> ------------------•---=------------------------- ------- ------------------- ------ ------------------------------- <br /> -- ---------------------------------------------------------------------------------------- <br /> --------- ------------- --------------------------------------------------------------------!-------------------------------------------------------- ------------------I---------------------- -------------------------------- <br /> - ---------- _ - ---- --- ---------- -------- --------- ---------------- -------- ------ ------------------------------------------------------------------------------------------------- ----- <br /> FINAL INSPECTION --- ---------- Date-- --- ------Y-716a------------ --- ------ ---- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 116011.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED P-S9 3M 3-'63 F.F.00. <br />