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, '^S•'.r <br /> APPLICATION FOR SANITATION PMIT Permit <br /> {Complete in Duplicate) 1 <br /> Date'la :..'.1..�. �. <br /> AjI plication is hereby made to the San Joaquin total Health Di:,trict for a permit to construct and install the work herein described <br /> This application is made in compliance with County Ordnance No. 544. <br /> t wit C1 ............................ADDRESS <br /> Owner's Name...9sA�.._... <br /> °....H.Q.3-5743 <br /> .......yA <br /> $8�i9 hone <br /> iAddress.......... ....................................................... ................... <br /> i Ir Contractor's IJ ame.....I���S $EPT s^-T!INIS. SSIa�Y.�Cf:'i-•......................••-.... .......................................... Phone 4-=6- <br /> a.; Installation will serve: ResidenceM Apartment House Commercial 1 <br /> Pa ❑ ❑ Trai!er Court © . Motel ❑ Other ❑., <br /> I ` Number of living units: -: ... Number of bedrooms A—. Number of baths ...I.. Lot sizAOQX235........I <br /> }. a Water Supply: Public system ❑ Community system ❑ Private K) Depth to Water Table .35.. ft. <br /> ' Character of soil to a depth of:3 feet: Sand❑ Gravel❑ Sandy Loam❑ Clay Loam❑ Clay❑ Ad° F Hardpan❑ <br /> `' . <br /> ' Frovious Application Made: Yes ❑ No Q New Construction: Yes ❑ No ❑ FHA/VA:Yes❑ No-13 ' <br /> . �f <br /> s TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .S (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> g <br /> Septic Tank- Distance from nearest well.................Distance f m foundation............ ....Material........C.0. b1d.0kNo of compartments...-,...2...- -- .....Size.........� X�4 <br /> ................ <br /> Liquid clepth...36.AA....... Capadty _.BOQ <br /> Disposal Field: Distance from naereLt well. .......tt'.Distance from foundation_ �15 ..Dissents to nearest tot line.h! <br /> Ll <br /> Number of lines..... r <br /> ..................•---....._--Length of each line._....�._,_.tia.........Width of trench---.243,a...--•• <br /> "a 31=p Type of filter material...9*.,__.••..-_Depth-of filter material.... Total length' 383!)...:..... -�-4�.---._...._.....:...a_.: .'. <br /> � - <br /> 4 Number of pits........ ...........Lining material.............•---....Size: <br /> Diameter. _..g....... <br /> 58 ,E Distance to nearest wel1....���s.- <br /> "rest Ipt <br /> .....D"++stance f oundation___.._ t Distance to nee - <br /> I . <br /> i Cesspool: Distance from nearest well............... Distance from foundation..-..._...........:.Lining material.`_...:..... ..._......_.....::......4 - <br /> n , <br /> : ' '.1 <br /> I [] Size: Diameter. Depth....................... Liquid Ca c� <br /> i 4 Pa ty Is. <br /> Privy: Distance from nearest well......... = <br /> ---.-.._------ ------------Distance from merest build' <br /> : Cl Distance to nearest lot tino................................. .......'..-..............._____. ...... _:.._.....9«...'........-. i. <br /> kD _ - <br /> Pr-modeling end/or repairing (describe):..................._............................... <br /> .........................__ ....w....... ........ y } <br /> •. ......_ <br /> „r p <br /> ...................................................... ......._..._._._._..................__... »..... .._...- . . .. .._..._... -- , <br /> .........................................................__......_._..-._.................:......... —-- :... ..:.._._:................. <br /> I hereby certify that 1 have prepared this applieation'and that fhe work will be dorso in accordance witty San_ Joaquin Cour ' <br /> ordinances, State laws, and rules ani regulations of the Sere Joaquin UwA Health District. & <br /> • <br /> I ...... . 1�.::_..�3►s.�i!...-..S�kY.IC�......................... :...... ......... <br /> :a �+ �j� <br /> L..Art ........... <br /> l�W p!^ <br /> • .._.(Title)......._ .. .-- ......_., ..._. ....... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side' k ; <br /> r, _._ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY................... <br /> ............... - ................ ................ - -DATE-_------- ». <br /> t� RFVIEWED BY....... - <br /> DATE. <br /> BUILDING i'f:RMIT ISSUIrD.._.................................:...... ..... - ------ DATE.............--•---- - ,.._. <br /> f' •*' Alterations and/or reaommendationsc............. - �-•`--w- <br /> '. ................................................................................... <br /> ..... ... .............................................................. .. <br /> PYA. _ ................................................................................................................................ <br /> [' ............ .....................................................-.................... �...... - - - . <br /> P • <br /> i <br /> .......................... ........... ...........................................-......... — t,J <br /> =ih:AL INSPECTION BY:.......... <br /> _.t.rr./I.. ...................J........... Dete.._:f `2 �.. .. ti+. <br /> s <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT " <br /> 134 SoAh American Street �i 100 Wosi Qek Stroo In Syumor.Stroo /t<Mw 'C'Sheent <br /> SicciMn. Cal'rForn:a Lodi, California -Mantow CerAony T yr [x <br /> i <br /> --Jtif Reritna 1.57 F PCO. <br /> ' <br /> �24 <br /> ,r fur:: ., _ <br />