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FOR C)FF!CF USE: <br /> .... . ....... ....... . <br /> ............. ............ ....... ......... APPLICATION FOR SANITATION PERMIT Permit No. <br /> .r............... <br /> .. ..................... .. .................. (Complete In Duplicate) <br /> ....................... ......................... This Permit Expires 1 Year From Date Issued Date <br /> Application is hereby made to the Son Joaquin Local Heafth District for a permit fo construct and ins­tai^.,.Q,k hemi-n (j,escribed. <br /> 15— P <br /> This application is made in compliance with County Ordinance No. 549. A 4 �? <br /> t ;041 <br /> JOB ADDRESS AND LiCCATION44e..S ._d9041,00.e��*_?..Aka.-.14. <br /> Owner's Name__..--_-/7_e7A.a?(1L <br /> ...................7 ---------------- -------- . . ......... ------- <br /> Add <br /> ress---------- ...... -,?-----------;?r,--T--W_41V <br /> Contractor s Name............. ---_-------------- --------------_------ - ------_------_--------- Phone--------- ------ -------------- --- <br /> Installation will serve: Residence RT'* Apartment House 0 Commercial El Trailer Court El Motel 0 Other <br /> Number of living units: J.. Number of 69clroonns..Z. Number of baths ./.. Lot size <br /> le f.... <br /> . ....................... <br /> ff <br /> Wafer Supply: Public system El Community system 0 . Private Zt'_Depth to Water Table _Joeff. I <br /> Character of soil to a depth of 3 feet: Sand-E] Gravel El 'S!1 ndy Loam E] Clay Loam &""bay [I Adobe El Hardpan El <br /> Previous Application Made: (1f yes,date...... ...... .1 No [-Ne*w Construction: Yes 93" ,lo n FHA/VA. Yes 77 No -Z:_- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 #_ -1i I i <br /> (No sopfic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T k: Distance from nearesf we.l__160,29---Distance flprn founcla4icn- 149, <br /> A* <br /> ......Capacity.. ... <br /> No. of compartments---A.,.. . ........Size Liquid depth... /I <br /> Disposal Field: Distancefr,;im nearest we]... ...DIsfance from foundati "_-Distance to nearest lot line <br /> Number of lines.._.___- ------L-engfh of each .........._.W,&fh of-french.,,,'," <br /> Type of filter material../��__ _ Z-_CboFiA of filte, material...../4e.�'.,,rofl <br /> Seepage P;f: Distance to nearest well----Z.4.2,P---f61sforice frf d t'; n...X&O.1 <br /> -2m oup a o ....Distance to rearest lot <br /> Number of p;fs..... rnaioi1al..Xa-j91C _Size: Nameter-.�Z_40 <br /> Cesspool: Distance from nearest well.......07!Dista,;co,from founclaticri................ <br /> Lin'-ng rnaferial...................... ...... <br /> Size- Diarreier.................. .......... . fDo--fh <br /> . . ............. -.LL]qu;d Captcity <br /> ­w - <br /> Privy. Disfaic3 from n sorest ca from nearest bu;1,4irq <br /> El Distance to rearesi- lot line...--- . ........ ...........I....... <br /> Remodeling and/or repairing [desc 'be):------ - -- ---------------------- <br /> ri <br /> ......................................_............................._­p-------- .................. --------- ... ............... <br /> ...................__.........................._­........._..____.................................................. ............ ..............;..................... <br /> .... .. ..................... .................... .............._•---••--••••--•-•---..... .............. . ....._...---- <br /> I <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 and regulations of the San Joaquin Local Health District. <br /> (Signed)..................... ...... .......... .... ... ..................................(Gwavar-arrd�cr Confrodor) <br /> By:....... .............................................................. ....... <br /> (Plot Plan- showing siva of lot, location of system in rela io wells, buildings, c., can be plated on reverse sadel. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... ..................................................... DATE. .................................... <br /> REVIEWEDBY.........................................•...._............_•.. . - -... ................. DATE.._..._...... ..................... <br /> BUILDING PERMIT ISSUED_______________..... ............. .......................­..­ DATE..........I....I............ <br /> Alterations and/or recommendations:..._................. ............. ................................................... ............ <br /> ...........................11........ ..........................................I....... . ............................... <br /> ............................................ <br /> ............................--••-•. .......................................-_....__-.._......•.......-. ....._....-............. ..... ... ........................ <br /> .....................I............. . ................ ....... . ................................ ..............................................-............- <br /> ....-••••............. <br /> .................................. ---­----­­--- ..................... ........................—.1.1.................................................. ......... <br /> FINAL INSPECTION BY:. Daie <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave. 300 Wav 0*k Str**t 124-Sycamore Street 205 West 9th Str"i <br /> SoeckPon,Cofifornia Lodi, California Marleca,California Tiacy,carifqfnio <br /> r.p.rzo, <br />