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IFFICE USE: <br />6 <br />Permit No. <br />APPLICATION FOP, SANITATION PERMIT 0 <br />friplote in Dupr"+*) Y., 4 7-,` DateIswed <br />..... (co <br />Tiiis Pormit, ExPiral I Year from Date Issued <br />^pplica'ition is hereby made to the San Joaquin Local Health D'istrict for a permit to constructianj install the work, herein described. <br />This application is made in compliance with County Ordinance o. 649. <br />JOB ADDRESS AND LrOy.... <br />owner's Name......._..... <br />.... . ...... <br />....... ... ------- <br />Address.- ....... __ ....... <br />C�tractor's Name-m.Zf ... ......... 1A Commercial C] Trailer Court (3 mptel 0 Other r <br />Inistauaftan will serve- Residencearfmont Hte <br />ZNumber of living units: Number of bedrooms - -.. Number of baths _/.. Lot size ... <br />Community system 0 Private Depth to Water Tal go ft. <br />Water Supply: Public system Ej $ 0 z in I <br />Character of soll fo a -depth of 3 feet: Sand 0 Gravel C] SanJy Loam 0 Clay Loam Clay 0 Adobe jg-Hardpe <br />Previous Application Made: (if yes, date-_-, .,1,,._.11..) No New Construction: Yes nj No JJ FHA/VA: Yes El C1 % <br />TYPE Or- tNSTALLATION AND SPECIFICATIONS: <br />(No septic tank.or cesspool permitted if public sewer is avail&66 within 200 fee" - <br />Material ........ <br />Distance from nearest .-Distance from foundatiOn....­-, <br />Liquid dept�' ............ <br />Ca ata <br />No. of oompartmenf& .... ... ....... <br />lot line.--l-P. ...... <br />Distance from +0 nearest <br />0;stance from n <br />tl�`d West we[ VJidtts of french­,A!T�'­ <br />­ <br />tap <br />Number of lines... Length of each line.A <br />Type of filter maferi6 "l-Tofal length­­ <br />..DWh of filter <br />�._ZOS_Qistance to nearest lot lire. ....... <br />Distance to nearest wee it Distance om f 4inclatiom <br />Di <br />9 Number o; pi+s­­J....... ..Lining materigl__, ..._.Size: ja ier., <br />d 'on_ ___' .... - _Lining .............. <br />Cesspool* Distance from nearest from oun aii <br />1t..Liqu;d Capacity -.1.-1 ....... -_gals. <br />Privy: Distaric e from nearest well., ....... . - .......... .............. .Distance from n1aresf <br />Distance to nearest lot fioe-­­­­--� <br />Remodeling an6/or repairing (describe):.._...,, .......... z:zx......... _ — ----- j <br />----.1-/------ <br />................ done i <br />n <br />I hereby certify ffiaH-have prepared this application and that the work be accordance with San Joaquin County <br />ordinances, St a rules ula+jons of the 'San Joaquin Local HealA District1 <br />.............. .................... . ........ <br />(PIC+ plan, showing size of J*+' location Of system in relatilon wells, 6ulWi etc., can placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY, , Ze4­,le-_ ................ D <br />...... DATE ------ - ....... <br />REVIEWED BY ....... ....... <br />BUILDING PERMIT ISSUED ........ BATE........................ <br />.......... _A <br />Alterations and/or recornmandatlons*_..... <br />A, <br />............ ....... ........ <br />—4- ...... ......... ............ ........ <br />........ . ....... .. . .... I ....... <br />....... - _-_ <br />FINAL INSPECTION BY:.,.. <br />rSASN JOAQUIN LOCAL HEALTH DISTRICT <br />W. 205 Woo 91h sitoot <br />Hemalt" Avv. 300 woo Oak stnoo 124 sytafflaft $+"�*f A <br />5t4ekw, Lodi, calife'"W <br />