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FOR OFFICE USE: � G <br /> i• �� 1 v`� APPLICATION FOR SANITATION PERMIT Permit No. ..G.G•- <br /> pw*1 %is D0110061 Da% hauad <br /> Thio Porn E121m 1 Yoar_F" Daio lauwrd <br /> Application is hereby made to the Sen Joaquin Laval He*%district for a permit to ca►sfroct and instep the work harem descrEsad• <br /> This application is made in co•r+pliance with Cou t Ordhance No. 549• ,r, <br /> J08 ADDRESS AND LOCATION...... ..7.X 9...... ... ..... r.... .....................»........»....»_...»............_.».._....."»----•--� f <br /> Owner's Name...th... .'G ................ »»... .,...»...».»..........»........---»••...-..•.. <br /> Addre:s..»...»,3..P..�...w..... <br /> �..... ..,�..... �,. _Y X:».: . »..»�.� ......PhbM...--.......--••-..~~"""" !t <br /> Contractor's Name................ ». Court 0M6W 13~ d111ir Q t! <br /> MstaEion afwill rve <br /> se : Residence (�' Apert-n••� (] Carnrnerdal ❑ Trout .•-- ..y <br /> Number of baths.A— Lot <br /> Number of living units.. ...�... NumW of bedroom*•-+ Table r1R itt <br /> Water Supply: Public system ❑ Community system (3 Priya%�+p water . Adobe�'tierdoae C) <br /> awaet+wr of soil to a depth of 3 feet: Sand E3 G"' p, Sandy Low 13 Clay Loam Q C*yi O <br /> Pnviow Application <br /> Made: (If yes dote.. J No LT NaW� • Yet 13 go (� <br /> TYPE OF WALLATION AND SPECIFICATIONSz ` <br /> (No nptk tank or cesspool pa im!ad if P h'Mw k wilh>w mar » <br /> Septic Tank: D';tence from nearest wetly!.•.••plsNTMa frbrr► n�t `"` �`"""'""" » » {,f,,,,�' <br /> Ner� o. of compartments....... ,,. .... .....SIM.—jit'>[ !'!.�•.......Lignid dapfhM <br /> Disposal Field: from nearest +r.. .pisfanta Proal founrla »»••••-� r�ere:t � <br /> Distance rin..» Of wench. �...._...._.... �.`. <br /> �-- Number of lines..... n qth of each »•--- <br /> Type of filter mete r%g�!<.,».-...Depth of fill«matariil.:.�'.j'»»�—Tow � <br /> Pit- Distance to nearest well.z ..ole f/oywldatia+.M. ►.........-� <br /> Seepage /...»........Lining�nta T.. ...ST:s: p`sanl�tw :r ,•_ --�•-- <br /> 0901Number of pits... �� <br /> Cesspool: Lin <br /> Distance from nearoO WOO ............Distanoa frara foundation. .a»...» <br /> .... »» <br /> ❑ Size: Diameter.................».....». .»».Depth.. ...».»........"..". . ......... "............. <br /> Distance from nearest well. ....... .......»"..,...»..»...D"lstaet+ll harts nearakt> -•••.»..'...'....,.....r... <br /> Distance to nearest lot lint....... ........................... .... ..-•-»=......»..•»..�...".--.,.w"'"."'�.""" ""..`...•... <br /> Remodeling end/or repairing (describe):...............,.......... "..»...".... »...................»..., W....» .....»....»..» �.�.....�. <br /> M.......!.....•...••....••.........•...'...........••................N•.N•M.......... <br /> „....".....w ..•..'•'.w.».W.•w"..•.• <br /> r........».N«N.....w+...............NNw......N... <br /> �4 <br /> � <br /> I lweb certify that 1 have prepared this appf atisln anal that 4be work ba.dens In <br /> S” M *04 <br /> ordbwmn>, laws, and rules and regnldtent of the San Joaquin LOW r'1!s %M*W- .. <br /> �1ed�................ ......... .,_.....»». ...,».....».. •N..(1MIa1..N»..... (OwM«Iowa CoNMrWMII!� <br /> ey:..........i .. t r `... «,,,,e,,,, 4 <br /> (Flet plea,showing size of lot,lac. of >n relalNen to wants. •t �".w.l'�""'� <br /> FOR OPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . L . .. ............».......................».................... <br /> REVIEWEDBY ....... . ..... ...... ............,................................... ...................M..............»..... . DATE.. »»........N..N..... :............-. <br /> BUILDING PERMIT ISSUED................. .. ... ................ Nr..........». ............»�D/tiTE... ....N.....N.....T— <br /> ................. <br /> Alteretions and/or recommendefkm ..1 <br /> :.. .'.L,$.a.4' 1.........L f.l+lti► <br /> .... . �4OT <br /> Itl»..rr.. .. 1 '..... — 1�..►� <br /> .......................... ..................................... .».. ..»....... ............................ <br /> . <br /> ... . ... ........ ..................................................................» ,..».,.fix.......» ..».....N. _ . <br /> FINAL INSPECTION BY: a Dah......L.:..� :. . i`».......»........... ..........._.. _».. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1"1!./Molten Ave. 300 WOO 00%1 1 /14 1oleo !ae WM►•1U IMrN <br /> {I•AMn,GI1119rnla <br /> Lodi,C4111em1e Traryr cswsm b <br /> r P Cc <br />