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KW OFFICE USE; <br /> ............ .................... ................ <br /> ----------- ............ ....... APPLICATION POR SANITATION PERMIT Permit No. <br /> ` _ .�1)':E?:�Cr!IFs/� ~�'�$ i This Vermif Exoiros 1 Year From Date luued(Complete in Duplicate) Date Issued ......FIL41�6 <br /> A -25-7i-06 <br /> �pliceflon is hereby made to the San Joaquin Local Health District for a permit to construct and install the work—the3crein described. <br /> T <br /> .5 application is made in compliance With County Ordinance No. 549. <br /> LO <br /> JOB ADDRESS AND CATIOW-AN. .... ...... <br /> Owner's Name........... <br /> ....... <br /> --- ........ <br /> ............. P <br /> Address.... iL t . <br /> Confraqtqr,'s_Namo.. <br /> Installaflion will serve: Residence Apartment House E] Commercial ❑ Trailer Court 0 Motel 0 Other E] <br /> Number of living units: ...t... Number of bedrooms -3. Number ofe <br /> I laths ...1.*-bof-sizepp"/00 K... <br /> Water Supply: Public system 0 40 4 <br /> Community system [] Private to Wafer Table ft.' <br /> Character of sail to a depth of 3 feet: Sand GrGravel 0 Sandy "0-al 19-j"rMI 'y 0 Adobe 0 Hardpan <br /> ❑ <br /> Previous Application Made: (If yes,date....... .. ....... ) No ( New Cons uc 1 1[9 6o [I FHA/VA:Yes [] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well....6_0-----Distance from foundation-_10-------- <br /> 7� No. of compartments......_2-—----------SiZe­X,.XJ4._,X,_5......Liiquid depth.......-.... Capacity../%66 <br /> Disposal Field: Pktance from nearest <br /> nce from foundation-. !.-Distance to nearest,lot line... ._.....,... <br /> w 11....N-,X�J.Disfa <br /> 0 1 <br /> 112— m as.:-14....... ....................Length of each line....e'! .--Width of <br /> ul ---- <br /> Type of filter ---Total length.......... ... ......... <br /> ,V, f4 <br /> Seepage Pit: Distance to nearret well..._.................Distance froqpAfcundafi;............... ....Distance to nearest lot line.........-_..... <br /> ❑ <br /> Number of pits....I.............._Lining material------!.*­... 7ne' . Diametai ---..................Depth................................. <br /> Cesspool: Distance from nalrest wall.....I ---....Distance from foundation...._-....... ....Lining material..........._._..-_-..._......-. <br /> ..._1----I............ ....DeptK........................ Liquid Capacity......................gals. <br /> ❑ Size: Diameter. I . . <br /> Distance from � if <br /> Privy: ita�—ncv�Fom ribisrest....... - building................................. <br /> F1 Distance to nearei!t lot I ine..............._ N <br /> Remodelinand/or repairing (clescriba)%.g 63�:6.7.. --i - - -- <br /> -------------------- ----- —--——------------------------------------------- - <br /> Wffa... <br /> BEEPRF........./.ht6.M020.11....... <br /> . ....J!0:54 <br /> WRV x----- <br /> ------�VA..5........................ <br /> ............. ........, ............. ------------------------------------­­-------------------­-------- <br /> I herebycertify that I have prepared this application and ". 4he work will be done in accordance with San Joaquin County <br /> ordinances, ate laws, and rule and regulations of the Sanjtic�r A District. <br /> �'u�t Local Heal <br /> (Signad�---4 �_... C, ­­V i I <br /> ------------ ..... ... .... _.-..... -1.............................. .....................lOwner and/or Contractor) <br /> By:....--........_......_:_....... ......................................... .. ....................... .....(Title).................................... <br /> (Plot plan, showing size of lot, location of system in relation to a , uildings, efc., can be placed on reverse side).......................... <br /> OR-DEPARiMER USEONUY <br /> APPLICATI <br /> ON4ACCEPTE BY....... ...... --------------- ----------------------jaATE_...... <br /> REVIEWED By -----_------ .------- tia"j. ...L............... <br /> BUILDING PERMIT ISSUE6...-.---- I----------------------------............­---------­�----.............. DATE.............................................. <br /> ...*----i--------------------------------------­­----------------------------------- DATE.........__..--_--._................... <br /> Allfisrefions and/or rectimittendeflo.s:----------------- ----------------------------- <br /> ..........................................2 <br /> ......................................... .................................................. <br /> .................................................................. ............-------------- ................ .......................................................................... <br /> ...................... <br /> ..................------------- <br /> .::i...... ................................... I....................._­'.'.__."­_*­**....................................... <br /> FINAL IN! P.T. <br /> Data..........4r.5=& <br /> ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Smult 300 Woof 0"Simo 124 Strawrion,$#too 205 Witt 9th Sfr..t <br /> Shields",California I <br /> . Lodi,C01110mid hio.t"o,California TrocY,C.Qfot.I. <br /> to P KZV19XD 0-87 RM 4-61 ATIAN <br />