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r <br /> FOR OFFICE USE: <br /> 11 APPLICATION FOR SANITA•fION PERMIT Pnrmit +o. ..-...f..,�_. ---• <br /> _-..-. (Complete in DujAcete) Date Issued <br /> ... ........................... . <br /> .•- - .. -. - - .-,--,-.._. .. . .. . ...-_... This Permit Expires 1 Year From Date Issued <br /> App;ica!ion is hereby made to the LAI <br /> .`;an Joaquin Local Health District for a permit to construct nn�j4rnsta i th��'�eiy e�cr�rb�e�. 0 <br /> This application is made in c:mr•liance with County Ordinance No. 549. 1 ' <br /> r <br /> ` ...... <br /> q . <br /> . <br /> JOB ADDRESS AND LOCATION..._. � ._ ........... <br /> Owner's Name..-.` P:............................. ....... . ..................................... Phone. <br /> .................................... <br /> Address.:.... - / i �'-.:�.'>r .-.j,.........................................................................................:•... . <br /> Phone.! / <br /> Contractor's Name........ ......... <br /> Installation will serve: Residence ❑ Apartment House Commercial C Trailer Court ❑ Mosel ❑ Other [3Number of living units: -.;2--. Number of bedrooms/--�.. Number of baths ....9.. Lot si.e ........ ---••-••-•--••---"•"- <br /> I Y Y ❑ •� 6..U. ft. <br /> ( Water Supply: Public system ❑ ----_--------------- <br /> Community s stem Priva.e• Depth to Neter Table - Adobe Hardpan[:3Character of soil to a depth of 3 reef: Send ❑ Gravel ❑ Sandy Lam ET-Clay Loam 0 Clay❑ Y s❑ No[ 3'___ <br /> Previous Application Made: ilf yes,date.. ... . _-._.. ) No New Construct;on: Yes L� No ❑ FHA/VA: <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 00 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) r <br /> Se ti Tank: Distance from nearest well-.-.J.�.....Distance from foundation-.L.c�..-._.._Mat��al--.-/�.Ca-act c6OD-....... �. <br /> X� No. of compartments.._..:3. ....-. ....Size..6.�L .5�.t ?..a:Liqu:d depth..-.-��`.//. .. P ty <br /> Disposal Field: Distance from nearest weil...J..�?.....Distance from fourdato`.. •:O•'••-•-.Distance to nearest lot line..... <br /> Number of lines............. .. .......Length of each line.....--�-..�..y•.....Width of •rench.-..._..�..�.:.....•_....... N <br /> x l L Total length................ 1/L��.�_.... O <br /> Type or filter materialS.r ..t -Ile_ of filer material......I�-•-• g <br /> Se pa a Pit: Distance to nearest well.....!!?�.....---.Distance from founcation.._.. a.•-•--_.DI`}�&e�+,oDneF{hs+lot line <br /> + K 2) Number of pits.......Z: ......Lining material. �� Size: Diameter....__-s.a <br /> Distance from nearest well................Distance from foundation-.................Lining material.........-_..................._....... r <br /> Cesspool: .Li Liquid Ca recit gals. <br /> ❑ Size: Cremator............ . ...... ......_....-.Depth.........-.....-......_-........ ....-._........ q F Y• -_..-._.----........_.... <br /> Distance from nearest building.......................................... . <br /> Privy: Distance from nearest %Bei...... ........................ •---1 <br /> Distance to nearest lot I;ne.. ...... ........ ......... ...................... <br /> ❑ . . _ <br /> r <br /> .� •..C,�,!-!3:::a�:-1................................... <br /> Remodeling and/ur re:-airing (describe):.-.....-. �...................... ...................................... <br /> ................................................ <br /> ....................... <br /> .....................................................•• -.e. --•••- in--cc -...._..-.......-_.._-.. -...-•---......-..- <br /> -----...I.. er.a.•-'• lication and that the work will be done in accordance with Sar. Joaquin County <br /> I hereby certify that I have prepared this app• <br /> ordinances, Sfa+elaws, and ruleand regulations <br /> gulations of the San Joaquin Local Health District. <br /> q (ownerand/or Contrac <br /> (Signed)......-...F• (Title)...... _r... .r. ......... . .. <br /> r , . <br /> (Plot plan, showing size of lot, location of system in relation to ......wells, buildings• etc., <br /> be Placed on eve se i de. <br /> — FOR DEPARTMENT USE ONLY - <br /> -- <br /> /1 .... ..... ........... .. ....................... <br /> DATE � 'a- <br /> APPLICATIOtJ ACCEP'E7 P'r.. 41..:. ... DATE.-. <br /> ..... ..... <br /> BUILDING f�RMiT ISSUED............................... ............... .... ...-... <br /> .......-..- -........-...- ..._..-....-................................................ ..-................. <br /> Alterations and/or recommendations:......... ... <br /> ............... <br /> .-....... .. <br /> Date <br /> FINAL iNSPECT 101, <br /> SAN JCAQUIN LOCAL HEALTH DISTRICT <br /> i 24 Sycamore Street 205 West 91h Srreer <br /> 300 W,CaliforniaestOak St-11601 E.Houtren Ave. Lodi, <br /> California Tracy,California <br /> lodiC <br /> Sleckren,California <br /> CS 9 RCVS r:D 6-.9 3- 3•'L7 r n CD <br />