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-----L <br /> ...57 c-61 ---- <br /> 13"CiL A6.o.ICATION FOR SANITATION PERN,,i Permit No. <br /> -----------------:------------------------------- - (Complete in Duplicate) Date Issued ... <br /> --- -- ----- ---------- ---­-------------- --- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-----4.12-SEP-------1.41F7Tq_N.......RoL................................................................................ <br /> Owner's NameMP.S_,,(.Q.k.AI-------X-e--iX.ft........_--------------------------------------------------__.............................. Phone--- <br /> ----—---------------------------------------------------------------------------------—---------------------------------............................... <br /> Contractor's Name.......... ------ ........................................................... Phone.14 <br /> ... <br /> Installation will serve: Residence Er Apartment House [] Commercial [] Trailer Court [] Motel [] Other 0 <br /> Number of living units: 1---- Number of bedrooms Number of baths _--1... Lot size ........1=.... ! _-.._..---------------- <br /> Water <br /> ---------------------- <br /> Water Supply: Public system C] Community system [] Private a-Depth To Water Table .16.Q ft. <br /> Character of soil to a depth of 3 feet: Sand C] Gravel [] Sandy Loam El Clay Loam B,Clay C] Adobe�Hardpan 0 <br /> Previous Application Made: (if yes,date-_....___.__.__-) No 5Z' New Construction: Yes Q1 No E] FHA/VA: Yes 0 No En-' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: "11� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> Septic Tank: Distance from nearest well...;5- _.Distance from foundation.,....2_0_j--_Ivlaterial.... <br /> 0 ;�i­........... <br /> iA No. of compartments----------Z ...... ..... ---T_Licluicl depfk------- ---Capacity.... <br /> Disposal Field: Distance from nearest well----6-P--- Distance from foundation.....A:n......Distance to nearest lot line_.2.0 <br /> Number of lines-............... -------------Length of each line._........20------------Width of trench----------2Y-.".......... <br /> Type of filter material... ---__Depth of filter material..._.le.........Total length..................2,02.___....... <br /> Seepage Pit: Distance to nearest well----ijeR_'._..._Distance'from founclation._XP'..._-.Distance to nearest lot line-__y__I... <br /> 1A Number of pits-------1............Lm _q <br /> ing ma�erial- r.cuiL_--- Size: Diameter-------13-, --4.....Depth.....------ <br /> Cesspool: Distance from nearest well_--..-____.... Distance from foundation_......... ---Lining material_.................................. <br /> El Size: Diameter-------------------------------------Depth-------_--------------- ------------------Liquid Capacity------------------------gals. <br /> Privy: Distance from nearest well..... -----_-----------------Distance from nearest building.._..._.._...-.............._--...... <br /> 0 Distance to nearest lot line----------------------------------............................­­------- -----------­.................... .-... <br /> Remodeling and/or repairing (describe):..-----'944-------/Vew-------si­_4EP_.7-/_ro........a llf.7-Cm... R. ,,_PJ n__ja I`_........... <br /> O-0.3='------- ------_---------------------------------_---------------------­--------­_­­......­­.....---------------------------­........................ - <br /> ----------­---------------------------•------------------------------------------`---__— .--•-------------------'-----------------'-----.......­---­ <br /> -- -- -- ------------------------------------------------------------------------------------ --------------------------------------------------------------------------- --------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules d regulations of the San Joaquin Local Health District. <br /> tSigned)---.....D_i,(A_ .�----0&49,6an ------0...... -----_IZ2_�. ------------ -- (0 a d/ Contractor) <br /> By:------_---j& --- --------------- --------------------------­----_-------(Title) 10 _ .. I----------- <br /> (Plot plan, showing size of lot, lova on of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.-, ------------------------- DATE.__3..'1A6r__1 ..e -------_..--- <br /> REVIEWED <br /> ------_......REVIEWED BY----------------......-------...._...----- . --- ---------------------....................................... DATE-----------'--_... . . .. <br /> BUILDING PERMIT ISSUED.............�4............... 77�-:- r— DATE... <br /> 714-------------------- Z::�---------------------------*-------------- <br /> 46 ................................................. <br /> ..............Altera ' ns and/or ropqrnmencrafloru --/`--"....... <br /> no- ------------------ V­-----­--------------­---------_--------------------------------- <br /> ----------------------------------------------------------J00,------------------------------------------------------------------------------------------------------------—----------------------------------------_ <br /> ................­­­------­---------------------------------------......­------------------------------------------------------------'-------- ------------------------------------ <br /> FINAL INSPECTION ........... Date ---------------------- <br /> _�YZ_)/SAN AQUI�N OCAL HEALTH DISTRICT r <br /> tae Sowth Amedeas Strut 300 West Oak street 124 Syc.tn.,.Street 205 West 9th Street <br /> swid",caufassik, Lodi,California Monte..,California T,ocy,California <br /> ES 9 REVISED a-59 ZM 5-62 ATLAS <br />